Provider First Line Business Practice Location Address:
200 W 5TH ST
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:
89445-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-304-4245
Provider Business Practice Location Address Fax Number:
775-201-5000
Provider Enumeration Date:
01/16/2024