Provider First Line Business Practice Location Address:
CORNER OF HWY NORTH 7 AND NORTH 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. 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:
928-729-8000
Provider Business Practice Location Address Fax Number:
928-729-8348
Provider Enumeration Date:
12/15/2017