Provider First Line Business Practice Location Address:
2106 N 24TH ST
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:
85008-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-277-5787
Provider Business Practice Location Address Fax Number:
602-277-7377
Provider Enumeration Date:
01/12/2007