Provider First Line Business Practice Location Address:
1513 W CRAIG RD
Provider Second Line Business Practice Location Address:
STE 1
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:
89032-0234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-368-2021
Provider Business Practice Location Address Fax Number:
702-368-2023
Provider Enumeration Date:
12/01/2010