Provider First Line Business Practice Location Address:
530E MCDOWELL RD 10-479
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:
85004-1549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-300-8135
Provider Business Practice Location Address Fax Number:
602-926-2746
Provider Enumeration Date:
08/22/2007