Provider First Line Business Practice Location Address:
1050 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-5483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-858-1868
Provider Business Practice Location Address Fax Number:
480-858-1867
Provider Enumeration Date:
07/07/2005