Provider First Line Business Practice Location Address:
20940 N TATUM BLVD
Provider Second Line Business Practice Location Address:
DESERT RIDGE MEDICAL CAMPUS BLDG B STE 290
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-538-2161
Provider Business Practice Location Address Fax Number:
480-585-9961
Provider Enumeration Date:
08/11/2006