Provider First Line Business Practice Location Address:
CORNER OF ROUTE 12 & 7
Provider Second Line Business Practice Location Address:
FORT DEFIANCE INDIAN HOSPITAL
Provider Business Practice Location Address City Name:
FORT DEFIANCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-729-8339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2011