Provider First Line Business Practice Location Address:
2002 E. CLARENDON AVE
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:
85251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-381-6080
Provider Business Practice Location Address Fax Number:
602-381-6094
Provider Enumeration Date:
02/28/2007