Provider First Line Business Practice Location Address:
25 WEST MAIN
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:
435-381-5464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007