Provider First Line Business Practice Location Address:
401 SOUTH 400 EAST
Provider Second Line Business Practice Location Address:
C O MOUNTAINLAND REHAB
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-397-8151
Provider Business Practice Location Address Fax Number:
801-397-8051
Provider Enumeration Date:
11/14/2006