Provider First Line Business Practice Location Address:
5555 W THUNDERBIRD
Provider Second Line Business Practice Location Address:
BANNER THUNDERBIRD MEDICAL CENTER
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-865-2627
Provider Business Practice Location Address Fax Number:
602-865-2631
Provider Enumeration Date:
09/14/2005