Provider First Line Business Practice Location Address:
1002 E. MCDOWELL RD.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006-2624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-388-4299
Provider Business Practice Location Address Fax Number:
602-388-4097
Provider Enumeration Date:
12/14/2006