Provider First Line Business Practice Location Address:
1204 SOUTH MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONOPAH
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-482-6711
Provider Business Practice Location Address Fax Number:
775-482-8767
Provider Enumeration Date:
05/23/2006