Provider First Line Business Practice Location Address:
MACKENZIE GOODWIN MD DBA WASATCH SURGICAL LLC
Provider Second Line Business Practice Location Address:
520 MEDICAL DR STE 300
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-273-9021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2012