Provider First Line Business Practice Location Address:
8222 S 48TH ST STE 205
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:
85044-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-806-6146
Provider Business Practice Location Address Fax Number:
602-610-7462
Provider Enumeration Date:
04/16/2007