Provider First Line Business Practice Location Address:
2601 E ROOSEVELT 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:
85008-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-344-5210
Provider Business Practice Location Address Fax Number:
602-344-5997
Provider Enumeration Date:
10/28/2005