Provider First Line Business Practice Location Address:
TWO RENAISSANCE SQUARE, 40 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 780, IHS CLINICAL SUPPORT CENTER
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-364-7777
Provider Business Practice Location Address Fax Number:
602-364-7788
Provider Enumeration Date:
08/23/2018