Provider First Line Business Practice Location Address:
240 US HIGHWAY 95A S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FERNLEY
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89408-9705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-575-5511
Provider Business Practice Location Address Fax Number:
775-575-6767
Provider Enumeration Date:
11/09/2005