Provider First Line Business Practice Location Address:
2727 W BASELINE RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85283-1068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-496-4444
Provider Business Practice Location Address Fax Number:
480-496-4450
Provider Enumeration Date:
11/21/2006