Provider First Line Business Practice Location Address: 
8841 E BELL RD STE 201
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SCOTTSDALE
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85260-1535
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
480-719-4750
    Provider Business Practice Location Address Fax Number: 
480-245-5086
    Provider Enumeration Date: 
12/17/2012