Provider First Line Business Practice Location Address:
2621 LOSEE RD
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:
89030-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-295-1473
Provider Business Practice Location Address Fax Number:
702-295-4323
Provider Enumeration Date:
10/23/2006