Provider First Line Business Practice Location Address:
29917 THACKER LATERAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWYHEE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89832-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-340-5277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2022