Provider First Line Business Practice Location Address:
1480 MAIN STREET
Provider Second Line Business Practice Location Address:
HWY 395
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:
775-782-7169
Provider Business Practice Location Address Fax Number:
775-782-7215
Provider Enumeration Date:
04/20/2007