Provider First Line Business Practice Location Address:
OFF HIGHWAY 191, PHS/IHS DRIVE
Provider Second Line Business Practice Location Address:
PO DRAWER PH
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:
928-674-7378
Provider Business Practice Location Address Fax Number:
928-674-7600
Provider Enumeration Date:
07/12/2019