Provider First Line Business Practice Location Address:
1423 N 16TH ST
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:
85006-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-232-1980
Provider Business Practice Location Address Fax Number:
602-253-4716
Provider Enumeration Date:
02/04/2010