Provider First Line Business Practice Location Address:
19555 N 59TH AVE
Provider Second Line Business Practice Location Address:
CLINICAL PSYCHOLOGY PROGRAM
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-6813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-572-3861
Provider Business Practice Location Address Fax Number:
623-572-3692
Provider Enumeration Date:
01/17/2014