Provider First Line Business Practice Location Address:
4350 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
B 120
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-279-5855
Provider Business Practice Location Address Fax Number:
602-926-8808
Provider Enumeration Date:
02/14/2007