Provider First Line Business Practice Location Address:
24 W CAMELBACK RD STE B
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:
85013-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-279-0889
Provider Business Practice Location Address Fax Number:
602-279-1071
Provider Enumeration Date:
12/21/2021