Provider First Line Business Practice Location Address:
213 EAST MONTEREY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-265-9393
Provider Business Practice Location Address Fax Number:
602-265-6456
Provider Enumeration Date:
07/25/2006