LARRY GLEN ANDREW

PROVO, UT
NPI1104996610
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207Q00000X Family Medicine
(Licence: UT  326767-1204)
Enumeration Date2006-11-09
Last Update Date2013-07-03
Business Address
LARRY GLEN ANDREW D.O.
746 E 1910 S STE 1
PROVO, UT 84606-6227
Phone number: 801-377-0580
Mailing Address
LARRY GLEN ANDREW D.O.
746 E 1910 S STE 1
PROVO, UT 84606-6227
Phone number: 801-377-0580
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