Provider First Line Business Practice Location Address:
5829 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-5812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-952-1188
Provider Business Practice Location Address Fax Number:
602-952-1302
Provider Enumeration Date:
01/19/2009