Provider First Line Business Practice Location Address:
1102 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85013-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-277-5444
Provider Business Practice Location Address Fax Number:
602-274-8821
Provider Enumeration Date:
05/23/2011