Provider First Line Business Practice Location Address:
1130 SMITH FIELD HOUSE
Provider Second Line Business Practice Location Address:
BRIGHAM YOUNG UNIVERSITY
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84604-8460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-422-2946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2019