Provider First Line Business Practice Location Address:
6741 N. 7TH ST.
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:
85014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-248-0428
Provider Business Practice Location Address Fax Number:
602-248-0496
Provider Enumeration Date:
09/20/2006