Provider First Line Business Practice Location Address:
70 SOUTH HIGHWAY 160 #104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-990-1642
Provider Business Practice Location Address Fax Number:
775-990-1646
Provider Enumeration Date:
07/11/2023