Provider First Line Business Practice Location Address:
1219 N 400 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84341-7556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-753-7000
Provider Business Practice Location Address Fax Number:
435-752-3856
Provider Enumeration Date:
12/15/2005