Provider First Line Business Practice Location Address:
1535 MEDICAL PARKWAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89703-4367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-445-7690
Provider Business Practice Location Address Fax Number:
775-883-5992
Provider Enumeration Date:
03/15/2010