Provider First Line Business Practice Location Address:
160 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-738-2034
Provider Business Practice Location Address Fax Number:
775-738-3241
Provider Enumeration Date:
09/19/2005