Provider First Line Business Practice Location Address:
1815 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
STE 314
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-649-0002
Provider Business Practice Location Address Fax Number:
702-399-2354
Provider Enumeration Date:
04/21/2006