Provider First Line Business Practice Location Address:
5259 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85031-2604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-849-1000
Provider Business Practice Location Address Fax Number:
623-873-7616
Provider Enumeration Date:
11/27/2012