Provider First Line Business Practice Location Address:
2302 W GREENWAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85023-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-942-2310
Provider Business Practice Location Address Fax Number:
602-942-1735
Provider Enumeration Date:
01/19/2006