Provider First Line Business Practice Location Address:
2035 MESQUITE SUITE E
Provider Second Line Business Practice Location Address:
LAKE HAVASU VA COMMUNITY BASED OUTPATIENT CLINIC
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
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:
928-445-4860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006