Provider First Line Business Practice Location Address:
2034 E SOUTHERN
Provider Second Line Business Practice Location Address:
4
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:
602-252-2133
Provider Business Practice Location Address Fax Number:
602-258-0123
Provider Enumeration Date:
08/02/2006