Provider First Line Business Practice Location Address:
606 N COUNTRY CLUB DR
Provider Second Line Business Practice Location Address:
#1 CLINIC OF PHYSICIANS AND SURGEONS
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85201-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-733-4400
Provider Business Practice Location Address Fax Number:
480-969-0976
Provider Enumeration Date:
08/11/2006