Provider First Line Business Practice Location Address:
131 E MAIN ST
Provider Second Line Business Practice Location Address:
STE. 3
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84654-1335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-528-2130
Provider Business Practice Location Address Fax Number:
435-528-2186
Provider Enumeration Date:
08/15/2006