Provider First Line Business Practice Location Address: 
10005 E OSBORN RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
SCOTTSDALE
    Provider Business Practice Location Address State Name: 
AZ
    Provider Business Practice Location Address Postal Code: 
85256-4019
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
602-263-1200
    Provider Business Practice Location Address Fax Number: 
602-263-1631
    Provider Enumeration Date: 
07/10/2008