Provider First Line Business Practice Location Address:
1661 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-3911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-241-1674
Provider Business Practice Location Address Fax Number:
602-230-7982
Provider Enumeration Date:
05/24/2007