Provider First Line Business Practice Location Address:
255 S HIGHWAY 55
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-637-6974
Provider Business Practice Location Address Fax Number:
435-637-8557
Provider Enumeration Date:
11/16/2006