Provider First Line Business Practice Location Address:
1395 NO. 400 E.
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-755-5000
Provider Business Practice Location Address Fax Number:
435-755-5099
Provider Enumeration Date:
04/16/2007