Provider First Line Business Practice Location Address:
3231 W COUNTY 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERTON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85350-7560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-341-6117
Provider Business Practice Location Address Fax Number:
928-341-6190
Provider Enumeration Date:
09/19/2008