Provider First Line Business Practice Location Address:
2100 S DECATUR BLVD
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:
89102-8505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-876-9606
Provider Business Practice Location Address Fax Number:
702-876-4366
Provider Enumeration Date:
10/23/2006