Provider First Line Business Practice Location Address:
18404 N. TATUM BLVD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-482-3100
Provider Business Practice Location Address Fax Number:
602-923-3463
Provider Enumeration Date:
01/22/2007