Provider First Line Business Practice Location Address:
300 E GURLEY ST
Provider Second Line Business Practice Location Address:
WASHINGTON TRADITIONAL SCHOOL
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-717-3281
Provider Business Practice Location Address Fax Number:
928-717-3280
Provider Enumeration Date:
04/18/2007