Provider First Line Business Practice Location Address:
1817 NORTH 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-257-4845
Provider Business Practice Location Address Fax Number:
602-257-4852
Provider Enumeration Date:
07/19/2007