Provider First Line Business Practice Location Address:
3000 S. 12TH AVENUE
Provider Second Line Business Practice Location Address:
PUEBLO MAGNET HIGH SCHOOL,
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-225-4317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2009