Provider First Line Business Practice Location Address:
162 W 100 S
Provider Second Line Business Practice Location Address:
LOGAN HIGH SCHOOL
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84321-5229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-755-2380
Provider Business Practice Location Address Fax Number:
435-755-2387
Provider Enumeration Date:
12/29/2006