Provider First Line Business Practice Location Address:
522 EAST SOUTHERN 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:
85040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-268-6030
Provider Business Practice Location Address Fax Number:
602-243-7024
Provider Enumeration Date:
02/27/2007