Provider First Line Business Practice Location Address:
8333 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-3440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-254-0676
Provider Business Practice Location Address Fax Number:
602-254-0677
Provider Enumeration Date:
09/12/2012