Provider First Line Business Practice Location Address:
1340 N 600 E
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-752-2230
Provider Business Practice Location Address Fax Number:
435-752-6481
Provider Enumeration Date:
06/18/2007