Provider First Line Business Practice Location Address:
650 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-266-8421
Provider Business Practice Location Address Fax Number:
623-302-5797
Provider Enumeration Date:
09/16/2006