Provider First Line Business Practice Location Address:
6592 N. DECATUR BLVD
Provider Second Line Business Practice Location Address:
SUITE # 115
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89131-1038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-396-4993
Provider Business Practice Location Address Fax Number:
702-636-4990
Provider Enumeration Date:
10/21/2010