Provider First Line Business Practice Location Address:
1201 E. BUTTE AVE
Provider Second Line Business Practice Location Address:
ARIZONA STATE PRISON COMPLEX
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-868-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006