Provider First Line Business Practice Location Address:
2601 E. ROOSEVELT STREET
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:
85008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-344-5188
Provider Business Practice Location Address Fax Number:
602-344-1233
Provider Enumeration Date:
05/23/2006