Provider First Line Business Practice Location Address:
5198 BOULDER HWY
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89122-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-450-5550
Provider Business Practice Location Address Fax Number:
702-450-5553
Provider Enumeration Date:
01/16/2007