Provider First Line Business Practice Location Address:
1105 S HIGHWAY 191 STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOAB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84532-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-259-1114
Provider Business Practice Location Address Fax Number:
435-259-1133
Provider Enumeration Date:
08/15/2023