Provider First Line Business Practice Location Address:
11011 SOUTH 48TH STREET
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85044-1787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-893-2400
Provider Business Practice Location Address Fax Number:
480-553-9545
Provider Enumeration Date:
10/12/2021