Provider First Line Business Practice Location Address:
2109 S. 48TH STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-424-2889
Provider Business Practice Location Address Fax Number:
602-424-2569
Provider Enumeration Date:
07/02/2006