Provider First Line Business Practice Location Address:
5426 LAKE CHARLES ST
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:
89031-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-287-0948
Provider Business Practice Location Address Fax Number:
702-664-0674
Provider Enumeration Date:
01/30/2011