Provider First Line Business Practice Location Address:
6601 W 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:
85033-3339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-846-1533
Provider Business Practice Location Address Fax Number:
623-846-6403
Provider Enumeration Date:
10/12/2009