Provider First Line Business Practice Location Address:
9445 S 50TH 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:
85044-5629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-708-4719
Provider Business Practice Location Address Fax Number:
602-680-1260
Provider Enumeration Date:
03/11/2009