Provider First Line Business Practice Location Address:
10 SOUTH FAIRGROUNDS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-2540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-637-4950
Provider Business Practice Location Address Fax Number:
435-637-4952
Provider Enumeration Date:
02/13/2007