| Name | SHANE D. ROSTERMUNDT, D.O. |
|---|---|
| Address | 2610 W HORIZON RIDGE PKWY STE 200 |
| City | HENDERSON |
| State | NV |
| Zip | 89052 |
| Mailing Address | 178 CRANBERRY ST |
| Mailing Address 2 | 178 CRANBERRY ST |
| Mailing City | ARROYO GRANDE |
| Mailing State | CA |
| Mailing Zip | 93420 |
| Agent Type | Noncommercial Registered Agent |
| Company | SHANE D. ROSTERMUNDT, D.O., P.C. |
|---|---|
| Entity Number | C12331-2002 |
| NV Business ID | NV20021316675 |