Provider First Line Business Practice Location Address:
1010 E INDIAN SCHOOL RD
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:
85014-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-243-7245
Provider Business Practice Location Address Fax Number:
480-522-3608
Provider Enumeration Date:
02/27/2008