Provider First Line Business Practice Location Address:
2505 HUALAPAI MTN RD. STE E
Provider Second Line Business Practice Location Address:
LIFEFITREHAB
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-718-4301
Provider Business Practice Location Address Fax Number:
928-718-4303
Provider Enumeration Date:
09/30/2008