Provider First Line Business Practice Location Address:
2929 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
STE 114
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-795-4787
Provider Business Practice Location Address Fax Number:
480-795-7778
Provider Enumeration Date:
12/27/2005