Provider First Line Business Practice Location Address:
625 N 6TH ST
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:
85004-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-406-8222
Provider Business Practice Location Address Fax Number:
602-406-0682
Provider Enumeration Date:
12/21/2005