Provider First Line Business Practice Location Address:
5410 E HIGH ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85054-5456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-282-8485
Provider Business Practice Location Address Fax Number:
480-323-2777
Provider Enumeration Date:
07/31/2008