Provider First Line Business Practice Location Address:
3320 W. SOUTHERN AVENUE
Provider Second Line Business Practice Location Address:
SUITE # 108
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-305-8800
Provider Business Practice Location Address Fax Number:
602-305-8801
Provider Enumeration Date:
12/27/2007