Provider First Line Business Practice Location Address:
50 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84025-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-451-3386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007