Provider First Line Business Practice Location Address:
5876 S. PECOS RD. BLDG. B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-733-0744
Provider Business Practice Location Address Fax Number:
702-796-8262
Provider Enumeration Date:
12/27/2012