Provider First Line Business Practice Location Address:
9043 W. OLIVE AVE.
Provider Second Line Business Practice Location Address:
FRY'S FOOD AND DRUG
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-979-1383
Provider Business Practice Location Address Fax Number:
623-979-8167
Provider Enumeration Date:
04/01/2010