Provider First Line Business Practice Location Address:
1 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRAIM
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84627-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-283-4444
Provider Business Practice Location Address Fax Number:
435-283-4070
Provider Enumeration Date:
01/04/2007