Provider First Line Business Practice Location Address:
1104 FERGUSON AVE
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:
89030-5391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-553-8139
Provider Business Practice Location Address Fax Number:
702-553-8139
Provider Enumeration Date:
08/28/2018