Provider First Line Business Practice Location Address:
2105 S 48TH ST
Provider Second Line Business Practice Location Address:
#105
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-264-1201
Provider Business Practice Location Address Fax Number:
602-264-4970
Provider Enumeration Date:
01/19/2007