Provider First Line Business Practice Location Address:
4680 S EASTERN AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89119-6192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-454-4336
Provider Business Practice Location Address Fax Number:
702-454-4268
Provider Enumeration Date:
11/09/2006