Provider First Line Business Practice Location Address: 
701 WEST WETMORE ROAD
    Provider Second Line Business Practice Location Address: 
AMPHITHEATER PUBLIC SCHOOLS
    Provider Business Practice Location Address City Name: 
TUCSON
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85705-1547
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
520-696-5237
    Provider Business Practice Location Address Fax Number: 
520-696-5067
    Provider Enumeration Date: 
04/11/2007