Provider First Line Business Practice Location Address:
10211 N 32ND ST
Provider Second Line Business Practice Location Address:
SUITE C-1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85028-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-996-0166
Provider Business Practice Location Address Fax Number:
602-996-1156
Provider Enumeration Date:
07/13/2006