Provider First Line Business Practice Location Address:
3639 W. LINCOLN 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:
85009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-233-9747
Provider Business Practice Location Address Fax Number:
602-352-5989
Provider Enumeration Date:
09/20/2006