Provider First Line Business Practice Location Address:
466 N MAIN ST
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-773-7060
Provider Business Practice Location Address Fax Number:
801-774-6100
Provider Enumeration Date:
10/30/2007