Provider First Line Business Practice Location Address:
280 N HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-613-1238
Provider Business Practice Location Address Fax Number:
435-613-1239
Provider Enumeration Date:
01/05/2007