Provider First Line Business Practice Location Address:
650 EAST INDIAN SCHOOL ROAD
Provider Second Line Business Practice Location Address:
VA LOCUM TENENS PROGRAM
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-626-7528
Provider Business Practice Location Address Fax Number:
602-761-5552
Provider Enumeration Date:
10/02/2008