Provider First Line Business Practice Location Address:
101 CIVIC CENTER LANE
Provider Second Line Business Practice Location Address:
HAVASU REGIONAL MEDICAL CENTER
Provider Business Practice Location Address City Name:
LAKE HAVASU
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-505-5760
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016