Provider First Line Business Practice Location Address:
3120 W CAREFREE HWY STE B-5
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:
85086-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-244-0371
Provider Business Practice Location Address Fax Number:
623-434-4657
Provider Enumeration Date:
03/20/2007