Provider First Line Business Practice Location Address:
10240 W. INDIAN SCHOOL RD.
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-251-6431
Provider Business Practice Location Address Fax Number:
623-271-9826
Provider Enumeration Date:
05/22/2007