Provider First Line Business Practice Location Address:
227 E BASELINE RD
Provider Second Line Business Practice Location Address:
J-1
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-264-6181
Provider Business Practice Location Address Fax Number:
480-264-7152
Provider Enumeration Date:
09/21/2007