Provider First Line Business Practice Location Address:
2824 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-6863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-840-0056
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2007