Provider First Line Business Practice Location Address:
590 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE DALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84513-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-381-5464
Provider Business Practice Location Address Fax Number:
435-381-5316
Provider Enumeration Date:
10/02/2006