Provider First Line Business Practice Location Address:
3714 E INDIAN SCHOOL RD STE 100
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:
85018-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-224-0004
Provider Business Practice Location Address Fax Number:
602-224-1182
Provider Enumeration Date:
09/14/2023