Provider First Line Business Practice Location Address:
1950 S HIGHWAY 89
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84302-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-542-9111
Provider Business Practice Location Address Fax Number:
208-542-9114
Provider Enumeration Date:
02/18/2015