Provider First Line Business Practice Location Address:
NAVAJO ROUTE 7 AND BIA ROUTE 102.1 (CO12-118
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-2190
Provider Business Practice Location Address Fax Number:
928-674-2191
Provider Enumeration Date:
04/09/2010