Provider First Line Business Practice Location Address:
3100 GLASSFORD HILL ROAD
Provider Second Line Business Practice Location Address:
FRYS FOOD AND DRUGS
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-445-0607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2007