Provider First Line Business Practice Location Address:
18850 E SCHOOL HOUSE RD
Provider Second Line Business Practice Location Address:
3
Provider Business Practice Location Address City Name:
BLACK CANYON CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85324-8787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-819-6787
Provider Business Practice Location Address Fax Number:
815-331-5323
Provider Enumeration Date:
09/15/2006