Provider First Line Business Practice Location Address:
747 S PARADISE CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-3175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-865-9119
Provider Business Practice Location Address Fax Number:
435-865-9115
Provider Enumeration Date:
07/22/2009