Provider First Line Business Practice Location Address:
1820 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
UNIT: N
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:
89030-7134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-301-6503
Provider Business Practice Location Address Fax Number:
702-387-8612
Provider Enumeration Date:
10/24/2013