Provider First Line Business Practice Location Address:
1108 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ- ARIZONA
Provider Business Practice Location Address Postal Code:
85013
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
602-773-5600
Provider Business Practice Location Address Fax Number:
602-773-5601
Provider Enumeration Date:
04/22/2015