Provider First Line Business Practice Location Address:
11638 N 12TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-799-9111
Provider Business Practice Location Address Fax Number:
602-293-3236
Provider Enumeration Date:
04/27/2006