Provider First Line Business Practice Location Address:
600 S STATE ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-1210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-240-1232
Provider Business Practice Location Address Fax Number:
801-515-5088
Provider Enumeration Date:
02/02/2026