Provider First Line Business Practice Location Address:
1910 IDAHO ST
Provider Second Line Business Practice Location Address:
SUITE # 101
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801-2692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-738-6256
Provider Business Practice Location Address Fax Number:
775-738-9469
Provider Enumeration Date:
02/01/2007