Provider First Line Business Practice Location Address:
1200 WEST RED BARN LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-650-8335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2014