Provider First Line Business Practice Location Address:
1231 E BASIN RD
Provider Second Line Business Practice Location Address:
STE 10
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-727-1366
Provider Business Practice Location Address Fax Number:
775-727-7116
Provider Enumeration Date:
10/25/2006