Provider First Line Business Practice Location Address:
4701 W INDIAN SCHOOL RD
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:
85031-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-245-2461
Provider Business Practice Location Address Fax Number:
623-247-0444
Provider Enumeration Date:
02/09/2007