Provider First Line Business Practice Location Address:
HWY 160 MP394.3
Provider Second Line Business Practice Location Address:
MILE POST 394.3
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4180
Provider Business Practice Location Address Fax Number:
928-697-4168
Provider Enumeration Date:
11/28/2015