Provider First Line Business Practice Location Address:
6218 S 13TH 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:
85042-4408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-276-4288
Provider Business Practice Location Address Fax Number:
602-232-2938
Provider Enumeration Date:
12/15/2006