Provider First Line Business Practice Location Address:
22707 S. ELLSWORTH RD H 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEEN CREEK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-792-9200
Provider Business Practice Location Address Fax Number:
480-792-9206
Provider Enumeration Date:
12/17/2007