Provider First Line Business Practice Location Address:
2400 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:
85201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-770-7450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2005