Provider First Line Business Practice Location Address:
4270 S DECATUR BLVD STE A-1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89103-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-798-7770
Provider Business Practice Location Address Fax Number:
702-895-7776
Provider Enumeration Date:
07/08/2006