Provider First Line Business Practice Location Address:
4975 S FORT APACHE RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-220-7646
Provider Business Practice Location Address Fax Number:
702-220-7631
Provider Enumeration Date:
06/17/2006