Provider First Line Business Practice Location Address:
1535 MEDICAL PARKWAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CARSON CITY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89703-4634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-883-5505
Provider Business Practice Location Address Fax Number:
775-883-6779
Provider Enumeration Date:
06/10/2006