Provider First Line Business Practice Location Address:
650 E INDIAN SCHOOL RD BLDG 4
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:
85012-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-277-5551
Provider Business Practice Location Address Fax Number:
602-222-6521
Provider Enumeration Date:
08/30/2006