Individual
JEREMY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
960 N DIXIE DOWNS RD, ST GEORGE, UT 84770-4206
(435) 628-0612
Mailing address
361 E 400 S, #8, ST GEORGE, UT 84770-3626
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
11/20/2009
Last updated
11/20/2009
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