Provider First Line Business Practice Location Address:
1300 EAST CENTER STREET
Provider Second Line Business Practice Location Address:
UTAH STATE HOSPITAL
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-344-4358
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2008