Provider First Line Business Practice Location Address:
635 E BASELINE RD
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:
85042-6551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-7277
Provider Business Practice Location Address Fax Number:
602-243-1235
Provider Enumeration Date:
12/16/2013