Provider First Line Business Practice Location Address:
4250 E CAMEL BACK RD
Provider Second Line Business Practice Location Address:
SUITE K250
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-254-9398
Provider Business Practice Location Address Fax Number:
602-252-6405
Provider Enumeration Date:
04/21/2006