Provider First Line Business Practice Location Address:
1101 FERGUSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
725-265-2864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2026