Provider First Line Business Practice Location Address:
6535 W CAMELBACK RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85033-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-848-1881
Provider Business Practice Location Address Fax Number:
623-846-0424
Provider Enumeration Date:
11/02/2010