Provider First Line Business Practice Location Address:
NAVAJO NATION RESERVATION
Provider Second Line Business Practice Location Address:
300 YARDS SOUTH OF FORT DEFIANCE FIELDHOUSE
Provider Business Practice Location Address City Name:
FORT DEFIANCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86504-1490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-729-4012
Provider Business Practice Location Address Fax Number:
928-729-4200
Provider Enumeration Date:
05/25/2007