Provider First Line Business Practice Location Address:
198 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-2430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-6131
Provider Business Practice Location Address Fax Number:
435-259-5369
Provider Enumeration Date:
02/13/2015