Provider First Line Business Practice Location Address:
2501 E CHEYENNE AVE
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:
89030-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-642-9672
Provider Business Practice Location Address Fax Number:
702-642-9682
Provider Enumeration Date:
11/01/2006