Provider First Line Business Practice Location Address:
115 W MERRITT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-442-1000
Provider Business Practice Location Address Fax Number:
928-777-8300
Provider Enumeration Date:
04/09/2012