Provider First Line Business Practice Location Address:
111 W. MONROE STREET
Provider Second Line Business Practice Location Address:
#131 DOWNTOWN PHOENIX DENTAL
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-626-7952
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2005