Provider First Line Business Practice Location Address:
1/2 MILE SOUTH OF KAIBETO MARKET BLDG #7986A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAIBETO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-673-3267
Provider Business Practice Location Address Fax Number:
928-673-3269
Provider Enumeration Date:
07/12/2019