Provider First Line Business Practice Location Address:
2150 E ORANGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-4814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-350-5878
Provider Business Practice Location Address Fax Number:
480-350-5865
Provider Enumeration Date:
12/18/2006