Provider First Line Business Practice Location Address:
350 EAST 300 NORTH
Provider Second Line Business Practice Location Address:
HERITAGE CONVALESCENT
Provider Business Practice Location Address City Name:
AMERICAN FORK
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-756-3847
Provider Business Practice Location Address Fax Number:
801-756-8705
Provider Enumeration Date:
01/30/2007