Provider First Line Business Practice Location Address:
3511 E INDIAN SCHOOL 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:
85018-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-899-6960
Provider Business Practice Location Address Fax Number:
602-899-6961
Provider Enumeration Date:
02/01/2016