Provider First Line Business Practice Location Address: 
7301 E 2ND ST
    Provider Second Line Business Practice Location Address: 
SUITE 300
    Provider Business Practice Location Address City Name: 
SCOTTSDALE
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85251-5600
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
480-949-9047
    Provider Business Practice Location Address Fax Number: 
480-994-5586
    Provider Enumeration Date: 
09/15/2005