Provider First Line Business Practice Location Address:
945 W HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE # 2
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-637-6190
Provider Business Practice Location Address Fax Number:
435-637-6317
Provider Enumeration Date:
08/19/2006