Provider First Line Business Practice Location Address:
10221 N. 32ND STREET
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85028-3849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-788-1138
Provider Business Practice Location Address Fax Number:
602-788-1136
Provider Enumeration Date:
10/18/2012