Provider First Line Business Practice Location Address:
4040 N MARTIN LUTHER KING BLVD
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:
89032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-331-9619
Provider Business Practice Location Address Fax Number:
702-331-7078
Provider Enumeration Date:
02/24/2016