Provider First Line Business Practice Location Address:
280 N HOSPITAL DR STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRICE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84501-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-637-4590
Provider Business Practice Location Address Fax Number:
435-637-4598
Provider Enumeration Date:
01/24/2007