Provider First Line Business Practice Location Address:
6450 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-304-9494
Provider Business Practice Location Address Fax Number:
702-304-9495
Provider Enumeration Date:
07/16/2006