Provider First Line Business Practice Location Address:
830 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNEMUCCA
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89445-2011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-623-3234
Provider Business Practice Location Address Fax Number:
775-623-1361
Provider Enumeration Date:
02/14/2012