Provider First Line Business Practice Location Address:
2627 S LAMB BLVD TRLR 47
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:
89121-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-200-6199
Provider Business Practice Location Address Fax Number:
702-485-4837
Provider Enumeration Date:
02/06/2023