Provider First Line Business Practice Location Address:
872 W HIGHWAY 40
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNAL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84078-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-781-8899
Provider Business Practice Location Address Fax Number:
435-781-8898
Provider Enumeration Date:
11/29/2011