Provider First Line Business Practice Location Address:
2141 E CAMELBACK RD
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-4764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-954-0954
Provider Business Practice Location Address Fax Number:
602-954-6018
Provider Enumeration Date:
02/22/2006