BRANT WAHLEN FONNESBECK

LOGAN, UT
NPI1033156849
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: UT  5953772-1204)
Enumeration Date2006-06-01
Last Update Date2008-02-26
Business Address
-- BRANT WAHLEN FONNESBECK DO
550 E 1400 N STE K
LOGAN, UT 84341-2450
Phone number: 435-755-6061
Mailing Address
-- BRANT WAHLEN FONNESBECK DO
325 W LOGAN HWY PO BOX 328
GARDEN CITY, UT 84028
Phone number: 435-764-7249
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