Provider First Line Business Practice Location Address:
1402 E. SOUTH MOUNTAIN AVENUE
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:
85042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-4231
Provider Business Practice Location Address Fax Number:
602-323-5988
Provider Enumeration Date:
10/07/2006