Provider First Line Business Practice Location Address:
12320 N 32ND ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032-7154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-992-1384
Provider Business Practice Location Address Fax Number:
602-992-6104
Provider Enumeration Date:
12/27/2006