Provider First Line Business Practice Location Address:
1102 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-273-7000
Provider Business Practice Location Address Fax Number:
602-273-7003
Provider Enumeration Date:
12/21/2015