Provider First Line Business Practice Location Address:
3829 E CAMBRIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85008-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-622-1290
Provider Business Practice Location Address Fax Number:
602-926-8036
Provider Enumeration Date:
12/21/2011