Provider First Line Business Practice Location Address:
6120 N 16TH 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:
85016-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-266-1195
Provider Business Practice Location Address Fax Number:
602-266-5122
Provider Enumeration Date:
04/23/2008