Provider First Line Business Practice Location Address:
130 N MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-712-3372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2010