Provider First Line Business Practice Location Address:
75 E 200 S
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
KANAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-644-5717
Provider Business Practice Location Address Fax Number:
435-644-5790
Provider Enumeration Date:
03/18/2006