Provider First Line Business Practice Location Address:
3333 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-852-0200
Provider Business Practice Location Address Fax Number:
602-852-0381
Provider Enumeration Date:
05/19/2006