Provider First Line Business Practice Location Address:
2000 W BETHANY HOME
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:
85015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-334-4227
Provider Business Practice Location Address Fax Number:
480-609-9350
Provider Enumeration Date:
07/25/2006