Provider First Line Business Practice Location Address:
2236 W BETHANY HOME RD
Provider Second Line Business Practice Location Address:
2
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85015-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-242-4592
Provider Business Practice Location Address Fax Number:
602-242-9220
Provider Enumeration Date:
06/04/2006