Provider First Line Business Practice Location Address:
1109 S. CHIEF AVE.
Provider Second Line Business Practice Location Address:
WHITE MOUNTAIN APACHE MOTEL.
Provider Business Practice Location Address City Name:
WHITERIVER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-338-4927
Provider Business Practice Location Address Fax Number:
928-338-4742
Provider Enumeration Date:
12/31/2009