Provider First Line Business Practice Location Address:
550 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
STE 122
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-234-1158
Provider Business Practice Location Address Fax Number:
602-234-9691
Provider Enumeration Date:
07/10/2007