Provider First Line Business Practice Location Address:
5555 N 7TH STREET
Provider Second Line Business Practice Location Address:
SUITE 142
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-265-8566
Provider Business Practice Location Address Fax Number:
602-265-8566
Provider Enumeration Date:
09/19/2005