Provider First Line Business Practice Location Address:
2345 E. CENTENNIAL PKWY.
Provider Second Line Business Practice Location Address:
SUITE 110
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:
89033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-987-1356
Provider Business Practice Location Address Fax Number:
702-361-2876
Provider Enumeration Date:
09/25/2006