Provider First Line Business Practice Location Address:
1300 EAST CENTER STREET
Provider Second Line Business Practice Location Address:
UTAH STATE HOSPITAL
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84603-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-344-4200
Provider Business Practice Location Address Fax Number:
801-344-4291
Provider Enumeration Date:
08/20/2007