Provider First Line Business Practice Location Address:
1327 S INTERSTATE DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-590-3471
Provider Business Practice Location Address Fax Number:
435-921-6620
Provider Enumeration Date:
03/28/2024