Provider First Line Business Practice Location Address:
990 MEDICAL DR STE U4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHAM CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-723-6487
Provider Business Practice Location Address Fax Number:
435-723-6490
Provider Enumeration Date:
08/30/2006