Provider First Line Business Practice Location Address:
EAST CEDAR AVENUE
Provider Second Line Business Practice Location Address:
SE TUBA CITY INDIAN MEDICAL CENTER LOT
Provider Business Practice Location Address City Name:
TUBA CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86045-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-283-6261
Provider Business Practice Location Address Fax Number:
928-283-6284
Provider Enumeration Date:
01/25/2006