Provider First Line Business Practice Location Address:
15262 N. 75TH AVENUE,
Provider Second Line Business Practice Location Address:
SUITE 400 PAIN SOLUTION CENTER, LLC
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85381-4762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-486-1510
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006