Provider First Line Business Practice Location Address:
HWY 163
Provider Second Line Business Practice Location Address:
BLDG KA-2010
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4167
Provider Business Practice Location Address Fax Number:
928-697-4168
Provider Enumeration Date:
04/09/2007