Provider First Line Business Practice Location Address: 
2238 E. GINTER ROAD
    Provider Second Line Business Practice Location Address: 
SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
    Provider Business Practice Location Address City Name: 
TUCSON
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85706
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
520-545-2137
    Provider Business Practice Location Address Fax Number: 
520-545-2120
    Provider Enumeration Date: 
08/28/2012