Provider First Line Business Practice Location Address:
2290 E FLAMINGO RD
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:
89119-0845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-454-8960
Provider Business Practice Location Address Fax Number:
702-735-0485
Provider Enumeration Date:
11/06/2006