Provider First Line Business Practice Location Address:
124 S. FAIRFIELD RD.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-774-0266
Provider Business Practice Location Address Fax Number:
801-719-6394
Provider Enumeration Date:
11/21/2006