Provider First Line Business Practice Location Address:
1400 N. 12TH STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
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:
602-521-5800
Provider Business Practice Location Address Fax Number:
602-521-5332
Provider Enumeration Date:
03/15/2007