Provider First Line Business Practice Location Address:
42631 NORTH 43RD DRIVE
Provider Second Line Business Practice Location Address:
KELLY'S ADULT THERAPEUTIC FOSTER HOME
Provider Business Practice Location Address City Name:
NEW RIVER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-670-4139
Provider Business Practice Location Address Fax Number:
623-551-8185
Provider Enumeration Date:
01/18/2007