Provider First Line Business Practice Location Address:
HWY 160/163, BLDG KA 2010
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033-0368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4110
Provider Business Practice Location Address Fax Number:
928-697-4083
Provider Enumeration Date:
01/30/2014