Provider First Line Business Practice Location Address:
19389 N 59TH AVE
Provider Second Line Business Practice Location Address:
MIDWESTERN MULTISPECIALTY CLINIC -- CLINICAL PSYCHOLOGY
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-537-6250
Provider Business Practice Location Address Fax Number:
623-537-6251
Provider Enumeration Date:
06/13/2012