Provider First Line Business Practice Location Address:
6460 MEDICAL CENTER ST STE 140
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:
89148-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-888-1340
Provider Business Practice Location Address Fax Number:
702-888-1342
Provider Enumeration Date:
03/21/2014