Provider First Line Business Practice Location Address:
2113 NORTH MAIN, STE.4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-590-0797
Provider Business Practice Location Address Fax Number:
435-867-1373
Provider Enumeration Date:
11/22/2006