Provider First Line Business Practice Location Address:
352 S 200 W
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-451-7900
Provider Business Practice Location Address Fax Number:
801-451-7211
Provider Enumeration Date:
09/16/2008