Provider First Line Business Practice Location Address:
6460 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-255-6647
Provider Business Practice Location Address Fax Number:
702-933-1444
Provider Enumeration Date:
07/27/2007