Provider First Line Business Practice Location Address:
I-15 EXIT 9 AT THE FIRESTATION
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLEFIELD
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86432-0490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-347-5971
Provider Business Practice Location Address Fax Number:
928-347-5793
Provider Enumeration Date:
04/26/2006