Provider First Line Business Practice Location Address:
3132 N 7TH 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:
85014-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-265-8190
Provider Business Practice Location Address Fax Number:
602-265-8049
Provider Enumeration Date:
06/28/2005