Provider First Line Business Practice Location Address:
483 SEED FARM ROAD
Provider Second Line Business Practice Location Address:
NEW BEGINNINGS BLDG
Provider Business Practice Location Address City Name:
SACATON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-528-7140
Provider Business Practice Location Address Fax Number:
620-528-7161
Provider Enumeration Date:
02/05/2008