Provider First Line Business Practice Location Address:
6867 W CHARLESTON BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89117-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-396-4165
Provider Business Practice Location Address Fax Number:
702-252-4405
Provider Enumeration Date:
12/27/2006