Provider First Line Business Practice Location Address:
9524 W CAMELBACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85305-3104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-872-8822
Provider Business Practice Location Address Fax Number:
623-772-8216
Provider Enumeration Date:
10/10/2005