Provider First Line Business Practice Location Address:
1424 S 7TH AVE BLDG C
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:
85007-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-258-3600
Provider Business Practice Location Address Fax Number:
602-256-0514
Provider Enumeration Date:
07/31/2006