Provider First Line Business Practice Location Address: 
EL RIO HEALTH
    Provider Second Line Business Practice Location Address: 
839 W CONGRESS ST
    Provider Business Practice Location Address City Name: 
TUCSON
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85745
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
520-670-3909
    Provider Business Practice Location Address Fax Number: 
520-309-2560
    Provider Enumeration Date: 
07/31/2014