Provider First Line Business Practice Location Address:
1854 E KINGS AVE
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:
85022-2856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-493-8252
Provider Business Practice Location Address Fax Number:
602-795-8642
Provider Enumeration Date:
10/08/2008