Provider First Line Business Practice Location Address:
CORNER OF ROUTE N7 & N12
Provider Second Line Business Practice Location Address:
TSEHOOTSOOI MED CTR
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:
928-729-8130
Provider Business Practice Location Address Fax Number:
928-729-8669
Provider Enumeration Date:
07/30/2008