Provider First Line Business Practice Location Address:
405 IDAHO STREET
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-778-9202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006