Provider First Line Business Practice Location Address:
9484 W LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
SUITE 8-10
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-243-7744
Provider Business Practice Location Address Fax Number:
702-243-9688
Provider Enumeration Date:
08/24/2006