Provider First Line Business Practice Location Address:
1311 E THOMAS RD
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:
85014-5707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-322-1315
Provider Business Practice Location Address Fax Number:
602-322-1316
Provider Enumeration Date:
12/21/2005