Provider First Line Business Practice Location Address:
13825 N 7TH ST.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-444-7972
Provider Business Practice Location Address Fax Number:
602-938-5135
Provider Enumeration Date:
07/08/2008