Provider First Line Business Practice Location Address:
10240 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-385-7900
Provider Business Practice Location Address Fax Number:
623-792-1233
Provider Enumeration Date:
08/18/2005