Provider First Line Business Practice Location Address:
3530 E INDIAN SCHOOL RD STE 5
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:
85018-5141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-224-5499
Provider Business Practice Location Address Fax Number:
602-274-5791
Provider Enumeration Date:
08/26/2008