Provider First Line Business Practice Location Address:
4100 W 20TH STREET
Provider Second Line Business Practice Location Address:
CIBOLA HIGH SCHOOL
Provider Business Practice Location Address City Name:
YUMA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-502-5908
Provider Business Practice Location Address Fax Number:
928-502-5869
Provider Enumeration Date:
06/13/2007