Provider First Line Business Practice Location Address:
2320 N. 20TH ST.
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:
85006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-254-2275
Provider Business Practice Location Address Fax Number:
602-212-2564
Provider Enumeration Date:
11/14/2006