Provider First Line Business Practice Location Address:
500 N. 3RD STREET MAIL CODE 3320
Provider Second Line Business Practice Location Address:
DOCTOR OF BEHAVIORAL HEALTH, ARIZONA STATE UNIVERSITY
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85004-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-496-1355
Provider Business Practice Location Address Fax Number:
602-496-1597
Provider Enumeration Date:
02/03/2007