Provider First Line Business Practice Location Address:
3155 W INDIAN SCHOOL RD
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:
85017-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-263-5126
Provider Business Practice Location Address Fax Number:
602-263-5070
Provider Enumeration Date:
12/07/2006