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1881997120
RUSSELL WILLIAM LUNDBERG
LOGAN, UT
NPI
1881997120
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
(Licence: UT 171M00000X)
Enumeration Date
2010-12-08
Last Update Date
2010-12-08
Business Address
-- RUSSELL WILLIAM LUNDBERG
90 E 200 N
LOGAN, UT 84321-4034
Phone number: 435-752-0791
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Mailing Address
-- RUSSELL WILLIAM LUNDBERG
166 W 100 N
SMITHFIELD, UT 84335-2002
Phone number:
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