Provider First Line Business Practice Location Address:
3190 S HIGHWAY 160
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-8904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-537-1000
Provider Business Practice Location Address Fax Number:
775-537-1079
Provider Enumeration Date:
12/12/2006