Provider First Line Business Practice Location Address:
2700 S HIGHWAY 191
Provider Second Line Business Practice Location Address:
STE. 1
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-3443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-5378
Provider Business Practice Location Address Fax Number:
435-259-3458
Provider Enumeration Date:
01/23/2007