Provider First Line Business Practice Location Address:
26224 N. TATUM BLVD.
Provider Second Line Business Practice Location Address:
STE. 1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-563-1111
Provider Business Practice Location Address Fax Number:
480-563-3044
Provider Enumeration Date:
05/31/2005