Provider First Line Business Practice Location Address:
117 WEST 200 SOUTH
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:
84025-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-451-4843
Provider Business Practice Location Address Fax Number:
801-451-2839
Provider Enumeration Date:
09/26/2006