Provider First Line Business Practice Location Address:
2929 E FILLMORE ST
Provider Second Line Business Practice Location Address:
415 N. 30TH ST
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-6159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-683-2500
Provider Business Practice Location Address Fax Number:
602-275-8677
Provider Enumeration Date:
12/12/2006