Provider First Line Business Practice Location Address:
NAVAJO RT 12
Provider Second Line Business Practice Location Address:
WINDOW ROCK UNIFIED SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
FT DEFIANCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-729-6757
Provider Business Practice Location Address Fax Number:
928-524-6367
Provider Enumeration Date:
12/15/2006