Provider First Line Business Practice Location Address:
176 W CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84741-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-644-2418
Provider Business Practice Location Address Fax Number:
435-644-2057
Provider Enumeration Date:
08/31/2006