Provider First Line Business Practice Location Address:
5102 W CAMPBELL AVE
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:
85031-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-848-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2005