Provider First Line Business Practice Location Address:
770 S HIGHWAY 160
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:
89048-4639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-751-8399
Provider Business Practice Location Address Fax Number:
775-751-8864
Provider Enumeration Date:
10/18/2011