Provider First Line Business Practice Location Address:
920 S. VULTURE MINE ROAD
Provider Second Line Business Practice Location Address:
SPECIAL SERVICES DEPT.
Provider Business Practice Location Address City Name:
WICKENBURG
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-684-6714
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007