Provider First Line Business Practice Location Address:
150 S HIGHWAY 160
Provider Second Line Business Practice Location Address:
C-11
Provider Business Practice Location Address City Name:
PAHRUMP
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89048-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-727-8818
Provider Business Practice Location Address Fax Number:
772-727-8870
Provider Enumeration Date:
07/29/2008