Provider First Line Business Practice Location Address:
2800 N 44TH ST
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:
85008-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-377-9960
Provider Business Practice Location Address Fax Number:
602-234-0606
Provider Enumeration Date:
01/15/2007