Provider First Line Business Practice Location Address:
1961 S IDAHO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89041-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-751-9579
Provider Business Practice Location Address Fax Number:
775-751-9579
Provider Enumeration Date:
10/18/2006