Provider First Line Business Practice Location Address:
1008 E MCDOWELL RD
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:
85006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-358-8588
Provider Business Practice Location Address Fax Number:
602-688-6991
Provider Enumeration Date:
12/10/2007