Provider First Line Business Practice Location Address:
198 EAST CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-6131
Provider Business Practice Location Address Fax Number:
435-259-5369
Provider Enumeration Date:
12/09/2014