Provider First Line Business Practice Location Address:
130 W 700 S
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84335-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-563-0140
Provider Business Practice Location Address Fax Number:
435-563-0164
Provider Enumeration Date:
06/09/2008