Provider First Line Business Practice Location Address:
16640 N 38TH 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:
85032-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-482-6671
Provider Business Practice Location Address Fax Number:
602-482-3541
Provider Enumeration Date:
10/10/2005