Provider First Line Business Practice Location Address:
5630 S PECOS RD
Provider Second Line Business Practice Location Address:
SUITE 2B
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:
702-560-5973
Provider Business Practice Location Address Fax Number:
888-753-3302
Provider Enumeration Date:
10/30/2012