Provider First Line Business Practice Location Address:
4800 N 22ND 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:
85016-4701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-955-1000
Provider Business Practice Location Address Fax Number:
602-508-4830
Provider Enumeration Date:
10/17/2005