Provider First Line Business Practice Location Address:
HWY 191 HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503-0277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-7223
Provider Business Practice Location Address Fax Number:
928-674-7559
Provider Enumeration Date:
01/05/2007