Provider First Line Business Practice Location Address:
189 S STATE ST STE 230
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:
84015-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-589-0819
Provider Business Practice Location Address Fax Number:
866-722-2081
Provider Enumeration Date:
01/27/2011