Provider First Line Business Practice Location Address:
4035 E INDIAN SCHOOL RD
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:
85018-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-321-2414
Provider Business Practice Location Address Fax Number:
480-497-5162
Provider Enumeration Date:
01/22/2007