Business Name
Physician First Name
Sam
Physician Middle Initial
Paul
Physician Last Name
Smith
Practice Name
Specialty
Dermatology
Office Designation
Primary
Address
4915 E. Baseline Road
85234
85234
Suite
Suite 102
City
Gilbert
State
AZ
County
Maricopa
Business Phone Number
(480)646-8660
Business Fax
(480)646-8665
ASPA Effective Date
1/2/2018