Provider First Line Business Practice Location Address:
10723 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85323-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-848-6991
Provider Business Practice Location Address Fax Number:
623-848-6993
Provider Enumeration Date:
02/13/2007