Provider First Line Business Practice Location Address:
5882 S HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
GLOBE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-425-2474
Provider Business Practice Location Address Fax Number:
928-425-2383
Provider Enumeration Date:
07/24/2007