Provider First Line Business Practice Location Address:
HIGHWAY 191 AND HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHINLE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-674-7166
Provider Business Practice Location Address Fax Number:
928-674-7705
Provider Enumeration Date:
04/10/2012