Provider First Line Business Practice Location Address:
105 W GOLDFIELD AVE
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
YERINGTON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89447-4222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-463-1622
Provider Business Practice Location Address Fax Number:
775-463-1552
Provider Enumeration Date:
11/20/2006