Provider First Line Business Practice Location Address:
NAVAJO RESERVATION
Provider Second Line Business Practice Location Address:
10 MILES WEST OF WHITE CONE FROM ROAD 77
Provider Business Practice Location Address City Name:
INDIAN WELLS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-521-2546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007