Provider First Line Business Practice Location Address:
921 S HIGHWAY 160
Provider Second Line Business Practice Location Address:
STE 409
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-727-3781
Provider Business Practice Location Address Fax Number:
775-727-3838
Provider Enumeration Date:
08/18/2005