Provider First Line Business Practice Location Address:
120 S STATE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-2252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006