Provider First Line Business Practice Location Address:
510 S 500 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNAL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84078-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-781-3500
Provider Business Practice Location Address Fax Number:
435-789-3201
Provider Enumeration Date:
07/12/2005