Provider First Line Business Practice Location Address:
9838 N 19TH AVE
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85021-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-331-7007
Provider Business Practice Location Address Fax Number:
602-331-7001
Provider Enumeration Date:
12/04/2006