Provider First Line Business Practice Location Address:
4001 S DECATUR BLVD STE 42B
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:
89103-5859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-221-0783
Provider Business Practice Location Address Fax Number:
702-221-2573
Provider Enumeration Date:
04/23/2008