Provider First Line Business Practice Location Address:
230 N HOSPITAL DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-637-8696
Provider Business Practice Location Address Fax Number:
801-637-9612
Provider Enumeration Date:
09/21/2006