Provider First Line Business Practice Location Address:
395 W MINOR 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:
89445-3863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-623-6622
Provider Business Practice Location Address Fax Number:
775-623-0979
Provider Enumeration Date:
08/31/2006