Provider First Line Business Practice Location Address:
7439 S 7TH ST
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:
85042-5443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-249-0288
Provider Business Practice Location Address Fax Number:
602-304-0170
Provider Enumeration Date:
07/30/2006