Provider First Line Business Practice Location Address:
250 E DUNLAP AVE
Provider Second Line Business Practice Location Address:
JOHN C LINCOLN HOSPITAL, ED
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-870-6353
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006