Provider First Line Business Practice Location Address:
3295 N DRINKWATER BLVD
Provider Second Line Business Practice Location Address:
STE 14-15 HOUSE LLC -
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-6492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-634-5440
Provider Business Practice Location Address Fax Number:
480-634-5038
Provider Enumeration Date:
10/28/2010