Provider First Line Business Practice Location Address:
HWY 160 1/2 MILE SOUTH OF MILE POST 394.3
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:
928-697-4165
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2018