Provider First Line Business Practice Location Address:
2700 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
STE 6
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:
89030-6512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-649-7708
Provider Business Practice Location Address Fax Number:
702-649-8074
Provider Enumeration Date:
07/31/2008