Provider First Line Business Practice Location Address:
2950 N 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-5410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-445-7575
Provider Business Practice Location Address Fax Number:
602-604-7938
Provider Enumeration Date:
11/29/2006