Provider First Line Business Practice Location Address:
504 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNEMUCCA
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89445-2827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-623-3938
Provider Business Practice Location Address Fax Number:
775-623-3939
Provider Enumeration Date:
09/24/2010