Provider First Line Business Practice Location Address:
3200 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-954-9473
Provider Business Practice Location Address Fax Number:
602-954-8494
Provider Enumeration Date:
07/28/2006