Provider First Line Business Practice Location Address:
1067 E. TABERNACLE
Provider Second Line Business Practice Location Address:
SUITE 7 ST. GEORGE OUTPATIENT VA CLINIC
Provider Business Practice Location Address City Name:
ST. GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-634-7608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2006