Provider First Line Business Practice Location Address:
1220 E. KORTSEN DR
Provider Second Line Business Practice Location Address:
CACTUS MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-421-3330
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007