Provider First Line Business Practice Location Address:
7071 N 138TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUKE AFB
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-536-0332
Provider Business Practice Location Address Fax Number:
623-536-0332
Provider Enumeration Date:
10/07/2005