Provider First Line Business Practice Location Address:
46 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE DALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84513-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-650-3733
Provider Business Practice Location Address Fax Number:
435-381-2255
Provider Enumeration Date:
07/01/2020