Provider First Line Business Practice Location Address:
921 S. HWY 160, ST. 203
Provider Second Line Business Practice Location Address:
ST. 203
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-419-6838
Provider Business Practice Location Address Fax Number:
775-204-1611
Provider Enumeration Date:
03/16/2011