Provider First Line Business Practice Location Address:
HC 70 BOX 30
Provider Second Line Business Practice Location Address:
#2014-1 PHS HOUSING; 1 MI. N. ON NAVAJO RT-16
Provider Business Practice Location Address City Name:
TONALEA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-209-6427
Provider Business Practice Location Address Fax Number:
928-672-3005
Provider Enumeration Date:
01/29/2013