Provider First Line Business Practice Location Address:
333 W INDIAN SCHOOL ROAD
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:
85013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-248-0368
Provider Business Practice Location Address Fax Number:
602-266-1958
Provider Enumeration Date:
08/17/2006