Provider First Line Business Practice Location Address:
4545 N. 36TH STREET
Provider Second Line Business Practice Location Address:
#125
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-224-0202
Provider Business Practice Location Address Fax Number:
602-224-0010
Provider Enumeration Date:
10/31/2006