Provider First Line Business Practice Location Address:
1017 E BASIN AVE STE 1
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:
89060-4532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-751-2184
Provider Business Practice Location Address Fax Number:
877-752-9402
Provider Enumeration Date:
10/23/2013