Provider First Line Business Practice Location Address:
44031 E PLUMOSA ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOUSE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-669-8512
Provider Business Practice Location Address Fax Number:
928-851-1828
Provider Enumeration Date:
07/12/2006