Provider First Line Business Practice Location Address:
150 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLEDALE
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:
435-381-5100
Provider Business Practice Location Address Fax Number:
435-381-5099
Provider Enumeration Date:
05/01/2012