Provider First Line Business Practice Location Address:
5316 E CAMBRIDGE 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:
85008-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-776-9763
Provider Business Practice Location Address Fax Number:
480-970-0003
Provider Enumeration Date:
11/03/2008