Provider First Line Business Practice Location Address:
290 S. MAIN 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-5959
Provider Business Practice Location Address Fax Number:
435-259-0174
Provider Enumeration Date:
09/29/2006