Provider First Line Business Practice Location Address:
46 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE DALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84513-0495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-381-5432
Provider Business Practice Location Address Fax Number:
435-381-5630
Provider Enumeration Date:
10/10/2007