Provider First Line Business Practice Location Address:
45 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-402-5142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2018