Provider First Line Business Practice Location Address:
4250 E CAMELBACK
Provider Second Line Business Practice Location Address:
SUITE K-250
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-8301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-253-9026
Provider Business Practice Location Address Fax Number:
602-252-6391
Provider Enumeration Date:
07/18/2006