Provider First Line Business Practice Location Address:
5735 S FORT APACHE RD STE B
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:
89148-5621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-870-0058
Provider Business Practice Location Address Fax Number:
702-870-0068
Provider Enumeration Date:
07/31/2007