Provider First Line Business Practice Location Address:
1001 E KNOX RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85284-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-752-8785
Provider Business Practice Location Address Fax Number:
480-820-3632
Provider Enumeration Date:
09/26/2006