Provider First Line Business Practice Location Address:
6813 OLD MAIN HL
Provider Second Line Business Practice Location Address:
CENTER FOR PERSONS WITH DISABILITIES
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84322-6813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-797-3822
Provider Business Practice Location Address Fax Number:
435-797-3944
Provider Enumeration Date:
05/02/2008