Provider First Line Business Practice Location Address:
824 S SAN FRANCISCO ST
Provider Second Line Business Practice Location Address:
BLDG 25 NORTHERN ARIZONA UNIVERSITY CAMPUS
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86011-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-523-6343
Provider Business Practice Location Address Fax Number:
928-523-5730
Provider Enumeration Date:
07/07/2006