Provider First Line Business Practice Location Address:
926 W 1700 S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-8530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-775-8880
Provider Business Practice Location Address Fax Number:
801-775-8890
Provider Enumeration Date:
08/31/2005