Provider First Line Business Practice Location Address:
CORNER OF RT. N12 AND N7
Provider Second Line Business Practice Location Address:
FORT DEFIANCE PHS HOSPITAL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-729-8757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2006