Provider First Line Business Practice Location Address:
7330 NORTH 16TH STREET
Provider Second Line Business Practice Location Address:
A120
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-997-6635
Provider Business Practice Location Address Fax Number:
602-997-6642
Provider Enumeration Date:
07/23/2006