Provider First Line Business Practice Location Address:
2119 E LAMAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-266-5095
Provider Business Practice Location Address Fax Number:
602-200-6021
Provider Enumeration Date:
06/12/2006