Provider First Line Business Practice Location Address:
12820 N 24TH 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:
85032-6902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-425-5479
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2023