Provider First Line Business Practice Location Address:
650 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
C/O CARL T HAYDEN VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-277-5551
Provider Business Practice Location Address Fax Number:
602-222-2679
Provider Enumeration Date:
08/17/2006