Provider First Line Business Practice Location Address:
2123 E. SOUTHERN AVENUE
Provider Second Line Business Practice Location Address:
OBOT ROOM #100
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-7531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-897-7044
Provider Business Practice Location Address Fax Number:
480-897-7943
Provider Enumeration Date:
01/23/2023