Provider First Line Business Practice Location Address:
5727 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-5809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-265-8597
Provider Business Practice Location Address Fax Number:
602-265-6811
Provider Enumeration Date:
10/10/2005