Provider First Line Business Practice Location Address:
1140 W 500 S
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:
84078-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-789-6300
Provider Business Practice Location Address Fax Number:
435-789-6325
Provider Enumeration Date:
02/16/2011