Provider First Line Business Practice Location Address:
40 W 1250 NORTH SUITE 8A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-244-4020
Provider Business Practice Location Address Fax Number:
385-244-4022
Provider Enumeration Date:
03/31/2006