Provider First Line Business Practice Location Address:
850 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84335-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-563-6201
Provider Business Practice Location Address Fax Number:
435-563-4034
Provider Enumeration Date:
08/25/2006