Provider First Line Business Practice Location Address:
SEEIP
Provider Second Line Business Practice Location Address:
15 E 600 N
Provider Business Practice Location Address City Name:
CASTLE DALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-381-2667
Provider Business Practice Location Address Fax Number:
435-381-2104
Provider Enumeration Date:
08/11/2023