Provider First Line Business Practice Location Address:
2435 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-205-0062
Provider Business Practice Location Address Fax Number:
480-775-2789
Provider Enumeration Date:
06/30/2008