Provider First Line Business Practice Location Address:
HIGHWAY 265 WEST & JUNCTION 191 SOUTH
Provider Second Line Business Practice Location Address:
SAGE MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
GANADO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-755-4500
Provider Business Practice Location Address Fax Number:
928-755-4659
Provider Enumeration Date:
10/17/2005