Provider First Line Business Practice Location Address:
1240 W. OWENS AVE STE 3
Provider Second Line Business Practice Location Address:
1240 W. OWENS AVE STE 3
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-877-9850
Provider Business Practice Location Address Fax Number:
702-877-9870
Provider Enumeration Date:
07/23/2013