Provider First Line Business Practice Location Address:
230 N HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-637-7960
Provider Business Practice Location Address Fax Number:
435-637-2128
Provider Enumeration Date:
08/15/2005