Provider First Line Business Practice Location Address:
4235 N CHIEFTAIN ST
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:
89129-2665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-481-4412
Provider Business Practice Location Address Fax Number:
562-481-4412
Provider Enumeration Date:
05/14/2026