Provider First Line Business Practice Location Address:
4720 E CHOLLA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85028-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-705-1144
Provider Business Practice Location Address Fax Number:
602-840-2139
Provider Enumeration Date:
06/24/2006