Provider First Line Business Practice Location Address:
5731 S FORT APACHE RD STE C
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:
89148-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-974-8666
Provider Business Practice Location Address Fax Number:
661-974-8669
Provider Enumeration Date:
02/19/2009