Provider First Line Business Practice Location Address:
6430 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-262-1353
Provider Business Practice Location Address Fax Number:
702-262-6828
Provider Enumeration Date:
02/15/2008