Provider First Line Business Practice Location Address:
250 N FAIRGROUNDS RD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-637-4660
Provider Business Practice Location Address Fax Number:
435-637-4690
Provider Enumeration Date:
11/07/2006