Provider First Line Business Practice Location Address:
2380 N 400 E
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-792-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2007