Provider First Line Business Practice Location Address:
84 ELKS PEAK 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:
89084-5200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-533-5613
Provider Business Practice Location Address Fax Number:
702-538-8452
Provider Enumeration Date:
01/28/2011