Provider First Line Business Practice Location Address:
310 S 100 E
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
KANAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84741-3632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-644-4520
Provider Business Practice Location Address Fax Number:
435-644-4524
Provider Enumeration Date:
05/19/2009