Provider First Line Business Practice Location Address:
7355 W ORANGEWOOD
Provider Second Line Business Practice Location Address:
DESERT SPIRIT SCHOOL
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-915-7353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007