Provider First Line Business Practice Location Address:
450 EAST CLINIC WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAROWAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84761-1690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-477-3344
Provider Business Practice Location Address Fax Number:
435-477-3475
Provider Enumeration Date:
09/29/2005