Provider First Line Business Practice Location Address:
4602 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
C3
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85031-2838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-247-0464
Provider Business Practice Location Address Fax Number:
623-247-3875
Provider Enumeration Date:
04/24/2007