Provider First Line Business Practice Location Address:
1466 N HIGHWAY 89
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-451-0475
Provider Business Practice Location Address Fax Number:
801-451-8249
Provider Enumeration Date:
12/29/2006