Provider First Line Business Practice Location Address: 
UNIVERSITY MEDICAL CTR
    Provider Second Line Business Practice Location Address: 
1501 NORTH CAMBELL AVE
    Provider Business Practice Location Address City Name: 
TUCSON
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85724-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
520-626-2761
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/14/2008