Provider First Line Business Practice Location Address:
150 S STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-825-0134
Provider Business Practice Location Address Fax Number:
801-773-1247
Provider Enumeration Date:
01/08/2008