Provider First Line Business Practice Location Address:
14231 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022-4360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-943-4220
Provider Business Practice Location Address Fax Number:
602-943-6808
Provider Enumeration Date:
04/20/2007