Provider First Line Business Practice Location Address:
5634 WEDGEFIELD ST
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:
89081-2433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-979-0547
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2011