Provider First Line Business Practice Location Address:
1201 S 7TH AVE
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:
85007-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-824-3324
Provider Business Practice Location Address Fax Number:
602-824-3383
Provider Enumeration Date:
12/03/2005