Provider First Line Business Practice Location Address:
1101 HWY 160 S.
Provider Second Line Business Practice Location Address:
SPACE 487
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-722-2451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2012