Provider First Line Business Practice Location Address:
3306 W ROOSEVELT 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:
85009-3404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-278-4930
Provider Business Practice Location Address Fax Number:
602-269-7772
Provider Enumeration Date:
11/06/2009