Provider First Line Business Practice Location Address:
ST GEORGE VA CBOC
Provider Second Line Business Practice Location Address:
230 NORTH 1680 EAST, BUILDING N
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-634-7608
Provider Business Practice Location Address Fax Number:
435-674-0092
Provider Enumeration Date:
10/02/2006