Provider First Line Business Practice Location Address:
2501 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-7669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-838-1555
Provider Business Practice Location Address Fax Number:
480-838-1777
Provider Enumeration Date:
03/16/2006