Provider First Line Business Practice Location Address:
6161 W CHARLESTON BLVD
Provider Second Line Business Practice Location Address:
BLDG 1
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-486-6054
Provider Business Practice Location Address Fax Number:
702-486-0417
Provider Enumeration Date:
02/27/2014