Provider First Line Business Practice Location Address:
4301 E GUADALUPE RD
Provider Second Line Business Practice Location Address:
HIGHLAND HIGH SCHOOL
Provider Business Practice Location Address City Name:
HIGLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85236-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-813-0051
Provider Business Practice Location Address Fax Number:
480-632-4797
Provider Enumeration Date:
01/10/2007