Provider First Line Business Practice Location Address:
195 TRIBAL CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IBAPAH
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-234-1138
Provider Business Practice Location Address Fax Number:
435-234-1202
Provider Enumeration Date:
11/14/2013