Provider First Line Business Practice Location Address:
E FIR ST
Provider Second Line Business Practice Location Address:
EXCEPTIONAL STUDENT SERVICES BUILDING
Provider Business Practice Location Address City Name:
TUBA CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86045-0067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-283-1160
Provider Business Practice Location Address Fax Number:
928-283-1265
Provider Enumeration Date:
07/05/2007