Provider First Line Business Practice Location Address:
4203 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85018-5359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-947-8381
Provider Business Practice Location Address Fax Number:
480-947-5338
Provider Enumeration Date:
12/03/2007