Provider First Line Business Practice Location Address:
8825 S 7TH ST
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:
85042-7626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-243-6121
Provider Business Practice Location Address Fax Number:
602-276-7390
Provider Enumeration Date:
08/22/2005