Provider First Line Business Practice Location Address:
70 S HIGHWAY 160
Provider Second Line Business Practice Location Address:
UNIT 101
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-382-5115
Provider Business Practice Location Address Fax Number:
702-825-7893
Provider Enumeration Date:
07/13/2022