Provider First Line Business Practice Location Address:
2320 N 3RD 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:
85004-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-340-0201
Provider Business Practice Location Address Fax Number:
602-340-0367
Provider Enumeration Date:
07/19/2006