Provider First Line Business Practice Location Address:
1000 HUMBOLDT AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-385-3305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2026