Provider First Line Business Practice Location Address: 
9295 E DESERT TRL
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SCOTTSDALE
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85260-4545
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
480-234-8667
    Provider Business Practice Location Address Fax Number: 
480-451-1951
    Provider Enumeration Date: 
03/31/2007