Provider First Line Business Practice Location Address:
1645 E. ROOSEVELT STREET
Provider Second Line Business Practice Location Address:
CLINICAL SERVICES
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-506-6660
Provider Business Practice Location Address Fax Number:
602-375-0342
Provider Enumeration Date:
06/17/2008