Provider First Line Business Practice Location Address:
1801 E CAMELBACK RD.
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85016-4165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-796-3141
Provider Business Practice Location Address Fax Number:
602-241-2860
Provider Enumeration Date:
04/29/2024