Provider First Line Business Practice Location Address:
1422 W CAMELBACK RD
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:
85013-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-462-5700
Provider Business Practice Location Address Fax Number:
602-362-5277
Provider Enumeration Date:
11/12/2025