Provider First Line Business Practice Location Address:
2810 OLD MAIN HILL
Provider Second Line Business Practice Location Address:
UTAH STATE UNIVERSITY
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84322-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-797-1457
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2011