Provider First Line Business Practice Location Address:
1689 E 1400 S STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-2267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-525-0007
Provider Business Practice Location Address Fax Number:
801-525-0008
Provider Enumeration Date:
12/28/2006