Provider First Line Business Practice Location Address:
175 W US HIGHWAY 50
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATELINE
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-687-3671
Provider Business Practice Location Address Fax Number:
775-687-6639
Provider Enumeration Date:
10/19/2006