Provider First Line Business Practice Location Address:
112 NO RESERVATION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCDERMITT
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89421-0315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-532-8522
Provider Business Practice Location Address Fax Number:
775-532-8024
Provider Enumeration Date:
02/13/2017