Provider First Line Business Practice Location Address:
3950 E SUNSET RD
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89120-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-221-7970
Provider Business Practice Location Address Fax Number:
701-221-7972
Provider Enumeration Date:
08/17/2006