Provider First Line Business Practice Location Address:
1840 E BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE C-2
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-751-3771
Provider Business Practice Location Address Fax Number:
480-751-3778
Provider Enumeration Date:
12/26/2007