Provider First Line Business Practice Location Address:
90 WEST MAIN
Provider Second Line Business Practice Location Address:
EMERY MEDICAL CENTER
Provider Business Practice Location Address City Name:
CASTLE DALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84513-0607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-381-2305
Provider Business Practice Location Address Fax Number:
435-381-4535
Provider Enumeration Date:
10/11/2006