Provider First Line Business Practice Location Address:
101 W CENTER ST
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:
84321-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-755-2300
Provider Business Practice Location Address Fax Number:
435-755-5231
Provider Enumeration Date:
05/02/2007