Provider First Line Business Practice Location Address:
4280 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-5374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-952-8667
Provider Business Practice Location Address Fax Number:
602-952-0129
Provider Enumeration Date:
11/28/2007