Provider First Line Business Practice Location Address:
2145 E. BASELINE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-241-9666
Provider Business Practice Location Address Fax Number:
480-491-3037
Provider Enumeration Date:
01/14/2009