Provider First Line Business Practice Location Address:
2828 E LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
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:
89030-6550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-218-1142
Provider Business Practice Location Address Fax Number:
702-224-2104
Provider Enumeration Date:
07/30/2015