Provider First Line Business Practice Location Address:
2219 N 5TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-738-9600
Provider Business Practice Location Address Fax Number:
775-738-9638
Provider Enumeration Date:
03/15/2007