Provider First Line Business Practice Location Address:
47 S 100 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025-2375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-451-5985
Provider Business Practice Location Address Fax Number:
801-451-5986
Provider Enumeration Date:
12/01/2006