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Individual

MR. WILLIS K CLYDE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
190 N MAIN ST, HEBER CITY, UT 84032-1600
(435) 654-0804
(435) 654-3314
Mailing address
PO BOX 13, HEBER CITY, UT 84032-0013
(435) 654-0804
(435) 654-3314

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
117343-2401
UT

Other

Enumeration date
10/25/2006
Last updated
04/23/2013
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