Provider First Line Business Practice Location Address:
OFF HWY 191 HIGHWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-725-9690
Provider Business Practice Location Address Fax Number:
928-725-9699
Provider Enumeration Date:
12/19/2006