Provider First Line Business Practice Location Address:
3545 TEMPE ST
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:
89103-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-620-0716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2013