Provider First Line Business Practice Location Address:
6410 MEDICAL CENTER ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-262-0079
Provider Business Practice Location Address Fax Number:
702-685-6910
Provider Enumeration Date:
11/01/2012