Provider First Line Business Practice Location Address:
8260 W INDIAN SCHOOL RD STE 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:
85033-2980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-247-2300
Provider Business Practice Location Address Fax Number:
623-247-1939
Provider Enumeration Date:
07/07/2005