Provider First Line Business Practice Location Address:
942 E. CHAMBERS ST.
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
SOUTH OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-475-7625
Provider Business Practice Location Address Fax Number:
801-476-7074
Provider Enumeration Date:
08/31/2006