Provider First Line Business Practice Location Address:
STATE ROUTE 264/US 191
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:
86505-0457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-755-4642
Provider Business Practice Location Address Fax Number:
928-755-4589
Provider Enumeration Date:
07/10/2006