Provider First Line Business Practice Location Address:
150 S. 12 STREET
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:
85034-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-495-5797
Provider Business Practice Location Address Fax Number:
602-262-6201
Provider Enumeration Date:
08/27/2009