Provider First Line Business Practice Location Address:
4823 SOUTH HWY 95
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
FT. MOHAVE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-704-4443
Provider Business Practice Location Address Fax Number:
928-704-1684
Provider Enumeration Date:
11/04/2010