Provider First Line Business Practice Location Address:
4701 WEST THUNDERBIRD ROAD
Provider Second Line Business Practice Location Address:
UNIVERSITY CENTER BUILDING, ROOM 190
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-543-8019
Provider Business Practice Location Address Fax Number:
602-543-8079
Provider Enumeration Date:
11/06/2007