Provider First Line Business Practice Location Address:
1400 N. 500 E.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-716-1000
Provider Business Practice Location Address Fax Number:
801-951-2389
Provider Enumeration Date:
10/03/2006