Provider First Line Business Practice Location Address:
1095 E. INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-274-9988
Provider Business Practice Location Address Fax Number:
602-263-8535
Provider Enumeration Date:
08/30/2006