Provider First Line Business Practice Location Address:
185 W DURFEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84029-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-270-7312
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2026