Provider First Line Business Practice Location Address:
1420 E HIGHWAY 372
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-727-6647
Provider Business Practice Location Address Fax Number:
775-727-1073
Provider Enumeration Date:
11/20/2006