Provider First Line Business Practice Location Address:
2525 E ROOSEVELT ST
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:
85008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-344-1015
Provider Business Practice Location Address Fax Number:
602-344-5149
Provider Enumeration Date:
07/12/2008