Provider First Line Business Practice Location Address:
2850 S. 3RD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-632-7199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2007