Provider First Line Business Practice Location Address:
1330 E HIGHWAY 193 STE C1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84040-8547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-821-2254
Provider Business Practice Location Address Fax Number:
801-821-2523
Provider Enumeration Date:
02/22/2006