Provider First Line Business Practice Location Address:
6005 S 36TH 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:
85042-4901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-595-5145
Provider Business Practice Location Address Fax Number:
602-595-5302
Provider Enumeration Date:
07/10/2008