Provider First Line Business Practice Location Address:
1515 N. 9TH STREET
Provider Second Line Business Practice Location Address:
STE. A
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:
602-258-5545
Provider Business Practice Location Address Fax Number:
602-252-6115
Provider Enumeration Date:
09/10/2014