Provider First Line Business Practice Location Address:
938 UNIVERSITY PARK BLVD STE 133
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-6284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-544-1673
Provider Business Practice Location Address Fax Number:
385-367-0096
Provider Enumeration Date:
08/29/2026