Provider First Line Business Practice Location Address:
300 N HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-363-4864
Provider Business Practice Location Address Fax Number:
801-423-3309
Provider Enumeration Date:
06/28/2006