Provider First Line Business Practice Location Address:
4520 E INDIAN SCHOOL RD STE 1
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:
85018-5434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-788-3437
Provider Business Practice Location Address Fax Number:
602-840-4868
Provider Enumeration Date:
12/13/2011