Provider First Line Business Practice Location Address:
539 E. GLENDALE AVE
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-241-3145
Provider Business Practice Location Address Fax Number:
602-241-3146
Provider Enumeration Date:
09/24/2009