Provider First Line Business Practice Location Address:
16601 N 40TH ST
Provider Second Line Business Practice Location Address:
JORDAN DEVELOPMENTAL PEDIATRICS SUITE 118
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85032-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-956-3141
Provider Business Practice Location Address Fax Number:
602-795-1671
Provider Enumeration Date:
01/13/2010