Provider First Line Business Practice Location Address:
15 EAST 600 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLE DALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-381-2447
Provider Business Practice Location Address Fax Number:
435-381-2511
Provider Enumeration Date:
11/28/2006