Provider First Line Business Practice Location Address:
500 NORTH HWY 89
Provider Second Line Business Practice Location Address:
BOB STUMP NORTHERN ARIZONA VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
180-094-9100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2006