Provider First Line Business Practice Location Address:
5656 S POWER RD
Provider Second Line Business Practice Location Address:
ST 142
Provider Business Practice Location Address City Name:
HIGLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85236-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-279-3100
Provider Business Practice Location Address Fax Number:
480-279-3150
Provider Enumeration Date:
08/02/2005