Provider First Line Business Practice Location Address:
6411 N. ROBERT RD.
Provider Second Line Business Practice Location Address:
HUMBOLDT UNIFIED SCHOOL DISTRICT #22/550
Provider Business Practice Location Address City Name:
PRESCOTT VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-759-4042
Provider Business Practice Location Address Fax Number:
928-759-4030
Provider Enumeration Date:
12/04/2012