Provider First Line Business Practice Location Address:
247 BLUFFS AVE
Provider Second Line Business Practice Location Address:
BLDG 1
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801-2455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-753-1049
Provider Business Practice Location Address Fax Number:
775-777-8494
Provider Enumeration Date:
12/21/2006