Provider First Line Business Practice Location Address:
380 NORTH 400 WEST
Provider Second Line Business Practice Location Address:
TANNER MEMORIAL CLINIC
Provider Business Practice Location Address City Name:
KAYSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-4840
Provider Business Practice Location Address Fax Number:
801-525-8151
Provider Enumeration Date:
11/17/2008