Provider First Line Business Practice Location Address:
19401 N CAVE CREEK RD
Provider Second Line Business Practice Location Address:
18 ITS NORTH CLINIC
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85024-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-996-0099
Provider Business Practice Location Address Fax Number:
602-996-1915
Provider Enumeration Date:
10/31/2006