Provider First Line Business Practice Location Address:
1300 N 12TH ST # 605
Provider Second Line Business Practice Location Address:
BANNER FAMILY MEDICINE CENTER
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006-2898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-239-2638
Provider Business Practice Location Address Fax Number:
602-239-2067
Provider Enumeration Date:
08/30/2005