Provider First Line Business Practice Location Address:
170 S ASH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-967-4204
Provider Business Practice Location Address Fax Number:
480-967-0049
Provider Enumeration Date:
08/30/2006