Provider First Line Business Practice Location Address:
3895 HARRISON BLVD
Provider Second Line Business Practice Location Address:
C/O 1ST FLOOR PHARMACY
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84403-8440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-387-8550
Provider Business Practice Location Address Fax Number:
801-387-8555
Provider Enumeration Date:
04/09/2019