Provider First Line Business Practice Location Address:
325 W. LOGAN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84028-0328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-946-3660
Provider Business Practice Location Address Fax Number:
435-946-8215
Provider Enumeration Date:
10/16/2006