Provider First Line Business Practice Location Address:
3031 S HIGHWAY 191
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-9441
Provider Business Practice Location Address Fax Number:
435-259-2431
Provider Enumeration Date:
09/16/2006