Provider First Line Business Practice Location Address:
3410 N 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-241-1944
Provider Business Practice Location Address Fax Number:
602-241-1917
Provider Enumeration Date:
08/16/2005