Provider First Line Business Practice Location Address:
305 CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST CARBON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-888-0422
Provider Business Practice Location Address Fax Number:
435-888-0860
Provider Enumeration Date:
07/24/2015