Provider First Line Business Practice Location Address:
4602 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITES C-3,C-4, AND D-2
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85031-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-247-0464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006