Provider First Line Business Practice Location Address:
4120 N 20TH ST STE B
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:
85016-6022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-284-9343
Provider Business Practice Location Address Fax Number:
602-651-1043
Provider Enumeration Date:
10/25/2006