Provider First Line Business Practice Location Address:
15920 S. 48TH STREET
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85048-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-961-2323
Provider Business Practice Location Address Fax Number:
480-961-2108
Provider Enumeration Date:
02/26/2008