Provider First Line Business Practice Location Address:
1820 E LAKE MEAD BLVD
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:
89030-0160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-475-4352
Provider Business Practice Location Address Fax Number:
702-356-8971
Provider Enumeration Date:
10/15/2024