Provider First Line Business Practice Location Address:
2632 N 20TH ST
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:
85006-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-266-2200
Provider Business Practice Location Address Fax Number:
602-240-6177
Provider Enumeration Date:
01/28/2006