Provider First Line Business Practice Location Address:
2700 W BASELINE RD
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:
85283-1072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-438-2807
Provider Business Practice Location Address Fax Number:
602-431-9592
Provider Enumeration Date:
06/10/2006