Provider First Line Business Practice Location Address:
3021 S 35TH ST
Provider Second Line Business Practice Location Address:
SUITE B-1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85034-7236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-454-0919
Provider Business Practice Location Address Fax Number:
602-454-7919
Provider Enumeration Date:
12/04/2006