Provider First Line Business Practice Location Address:
8433 N BLACK CANYON HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85021-4873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-249-8707
Provider Business Practice Location Address Fax Number:
602-788-0388
Provider Enumeration Date:
11/30/2006