Provider First Line Business Practice Location Address:
355 NORTH MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-644-4199
Provider Business Practice Location Address Fax Number:
435-644-8562
Provider Enumeration Date:
10/24/2006