Provider First Line Business Practice Location Address:
4501 W INDIAN SCHOOL RD
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:
85031-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-447-0225
Provider Business Practice Location Address Fax Number:
602-447-0783
Provider Enumeration Date:
02/23/2015