Provider First Line Business Practice Location Address:
13232 N TATUM BLVD
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:
85032-6459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-996-5200
Provider Business Practice Location Address Fax Number:
602-996-6160
Provider Enumeration Date:
08/24/2005