Provider First Line Business Practice Location Address:
466 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
CLEARFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84015-3222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-776-8441
Provider Business Practice Location Address Fax Number:
801-776-8428
Provider Enumeration Date:
01/22/2007