Provider First Line Business Practice Location Address:
5901 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE NUMBER 1
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85033-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-253-8888
Provider Business Practice Location Address Fax Number:
602-252-0845
Provider Enumeration Date:
04/10/2008