Provider First Line Business Practice Location Address:
6702 W BETHANY HOME RD STE 1314&15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85303-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-435-7000
Provider Business Practice Location Address Fax Number:
623-435-3947
Provider Enumeration Date:
11/20/2012