Provider First Line Business Practice Location Address:
650 E INDIAN SCHOOL RD BLDG 23
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:
85012-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-831-5837
Provider Business Practice Location Address Fax Number:
602-200-2326
Provider Enumeration Date:
07/22/2020