Provider First Line Business Practice Location Address:
HWY 160/163 BLDG KA2010
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:
928-697-4000
Provider Business Practice Location Address Fax Number:
928-697-4020
Provider Enumeration Date:
04/21/2009