Provider First Line Business Practice Location Address:
51 E HASKELL ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
WINNEMUCCA
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-623-0550
Provider Business Practice Location Address Fax Number:
775-623-3282
Provider Enumeration Date:
01/08/2007