Provider First Line Business Practice Location Address:
130 N MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84528-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-910-7286
Provider Business Practice Location Address Fax Number:
801-998-3635
Provider Enumeration Date:
01/06/2012