Provider First Line Business Practice Location Address:
1273 CANYON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84321-4326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-712-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2009