Provider First Line Business Practice Location Address:
822 HIGHWAY 198 STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAYSON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84651-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-465-1390
Provider Business Practice Location Address Fax Number:
18-465-0406
Provider Enumeration Date:
09/01/2006