Provider First Line Business Practice Location Address:
1501 E ORANGEWOOD AVE
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:
85020-5130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-944-1574
Provider Business Practice Location Address Fax Number:
602-626-8549
Provider Enumeration Date:
09/30/2005