Provider First Line Business Practice Location Address:
STAT MD, 1784 UINTA WAY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-604-0160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2019