Individual
COLT R MUND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
170 W 200 N, WILLARD, UT 84340-9752
(435) 734-9606
Mailing address
170 W 200 N, WILLARD, UT 84340-9752
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
—
—
Other
Enumeration date
05/02/2011
Last updated
05/02/2011
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