Provider First Line Business Practice Location Address:
3800 N 7TH 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:
85014-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-340-1766
Provider Business Practice Location Address Fax Number:
602-340-1761
Provider Enumeration Date:
07/11/2007