Provider First Line Business Practice Location Address:
600 W HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHAM CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-734-2041
Provider Business Practice Location Address Fax Number:
435-723-8028
Provider Enumeration Date:
08/31/2006