Provider First Line Business Practice Location Address:
2140 E BASELINE RD
Provider Second Line Business Practice Location Address:
T-1905
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85042-6910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-281-1120
Provider Business Practice Location Address Fax Number:
602-282-0754
Provider Enumeration Date:
04/08/2013