Provider First Line Business Practice Location Address:
HC 70 BOX 531
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARGOSA VALLEY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89020-9600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-372-1199
Provider Business Practice Location Address Fax Number:
775-375-1196
Provider Enumeration Date:
07/22/2009