Provider First Line Business Practice Location Address:
1366 S LEGEND HILLS DR STE 120
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-442-5144
Provider Business Practice Location Address Fax Number:
385-325-1407
Provider Enumeration Date:
04/23/2012