Provider First Line Business Practice Location Address:
18850 E. SCHOOLHOUSE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK CANYON CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-374-5215
Provider Business Practice Location Address Fax Number:
623-374-8969
Provider Enumeration Date:
01/22/2008