Provider First Line Business Practice Location Address:
393 WEST KA 2010 US HIGHWAY 163
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2014