Provider First Line Business Practice Location Address:
445 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84741-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-676-2599
Provider Business Practice Location Address Fax Number:
435-676-2585
Provider Enumeration Date:
10/28/2010