Provider First Line Business Practice Location Address:
7342 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:
85033-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-846-0085
Provider Business Practice Location Address Fax Number:
623-848-7535
Provider Enumeration Date:
10/12/2006