Provider First Line Business Practice Location Address:
6061 S FORT APACHE RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-736-0049
Provider Business Practice Location Address Fax Number:
702-736-0095
Provider Enumeration Date:
08/27/2007