Business Name
Physician First Name
Richard
Physician Middle Initial
Mark
Physician Last Name
Kootman
Practice Name
Specialty
Ophthalmology
Office Designation
Primary
Address
13943 N. 91st Ave
85381
85381
Suite
Bldg G
City
Peoria
State
AZ
County
Maricopa
Business Phone Number
(623)561-1995
Business Website Address
Business Fax
(623)561-2446
ASPA Effective Date
9/13/1993