Provider First Line Business Practice Location Address:
11071 S. CAMELBACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YUCCA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86438-0155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-377-9867
Provider Business Practice Location Address Fax Number:
928-447-0035
Provider Enumeration Date:
01/07/2026