Provider First Line Business Practice Location Address:
2600 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
BLDG. H
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-699-7248
Provider Business Practice Location Address Fax Number:
480-664-1961
Provider Enumeration Date:
07/15/2005