Provider First Line Business Practice Location Address:
8285 W ARBY AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-735-7154
Provider Business Practice Location Address Fax Number:
702-405-1862
Provider Enumeration Date:
11/27/2006