Provider First Line Business Practice Location Address:
3201 N 16TH ST
Provider Second Line Business Practice Location Address:
STE 12
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-7160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-279-2008
Provider Business Practice Location Address Fax Number:
602-445-9125
Provider Enumeration Date:
02/28/2008