Provider First Line Business Practice Location Address:
1815 E. LAKE MEAD BLVD
Provider Second Line Business Practice Location Address:
SUITE 215
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-818-1919
Provider Business Practice Location Address Fax Number:
702-399-5499
Provider Enumeration Date:
05/15/2006