Provider First Line Business Practice Location Address:
22 S STATE STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-393-5355
Provider Business Practice Location Address Fax Number:
801-394-4609
Provider Enumeration Date:
08/10/2007