Provider First Line Business Practice Location Address:
1740 W ADAMS ST
Provider Second Line Business Practice Location Address:
RM 205
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85007-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-542-1866
Provider Business Practice Location Address Fax Number:
602-542-2936
Provider Enumeration Date:
02/26/2007