Provider First Line Business Practice Location Address:
1380 E MEDICAL CTR DR STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84790-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-868-5570
Provider Business Practice Location Address Fax Number:
435-868-5575
Provider Enumeration Date:
06/22/2006