Provider First Line Business Practice Location Address:
150 S 12TH 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:
85034-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-261-8414
Provider Business Practice Location Address Fax Number:
602-534-4827
Provider Enumeration Date:
11/01/2006