Provider First Line Business Practice Location Address:
1212 E OSBORN RD
Provider Second Line Business Practice Location Address:
STE. 106
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-5533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-265-9555
Provider Business Practice Location Address Fax Number:
602-234-7923
Provider Enumeration Date:
01/26/2007