Provider First Line Business Practice Location Address:
600 E BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE B-6
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-839-6000
Provider Business Practice Location Address Fax Number:
480-839-6363
Provider Enumeration Date:
04/21/2011