Provider First Line Business Practice Location Address:
1 MILE NORTH ON HIGHWAY 163
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033-0487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-5570
Provider Business Practice Location Address Fax Number:
928-697-5574
Provider Enumeration Date:
01/10/2012