Provider First Line Business Practice Location Address:
1540 HWY 395
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
GARDNERVILLE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-782-7166
Provider Business Practice Location Address Fax Number:
775-782-7167
Provider Enumeration Date:
04/03/2007