Provider First Line Business Practice Location Address:
1235 8TH ST
Provider Second Line Business Practice Location Address:
ECFH LAS VEGAS CLINIC
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87701-4219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-425-6788
Provider Business Practice Location Address Fax Number:
505-425-5408
Provider Enumeration Date:
06/09/2010