Provider First Line Business Practice Location Address:
101 CIVIC CENTER LN
Provider Second Line Business Practice Location Address:
HAVASU REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-453-0411
Provider Business Practice Location Address Fax Number:
928-453-0418
Provider Enumeration Date:
12/26/2007