Provider First Line Business Practice Location Address:
150 N. 18TH AVE., SUITE 150
Provider Second Line Business Practice Location Address:
ARIZONA DEPART. OF HEALTH SERVICES
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-364-3859
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2006