Provider First Line Business Practice Location Address:
3925 N MLK BLVD STE 212
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:
89032-7676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-776-6728
Provider Business Practice Location Address Fax Number:
702-405-9361
Provider Enumeration Date:
10/24/2012