Provider First Line Business Practice Location Address:
1840 E BASELINE RD STE C-1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-426-2667
Provider Business Practice Location Address Fax Number:
480-751-3785
Provider Enumeration Date:
01/30/2006