Provider First Line Business Practice Location Address:
3132 E 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:
85016-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-957-4265
Provider Business Practice Location Address Fax Number:
602-954-7412
Provider Enumeration Date:
10/29/2010