Provider First Line Business Practice Location Address:
150 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-2637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-865-6665
Provider Business Practice Location Address Fax Number:
435-867-4880
Provider Enumeration Date:
08/30/2006