Provider First Line Business Practice Location Address:
6246 SO REDWOOD RD
Provider Second Line Business Practice Location Address:
AVALON BENNION CARE CENTER
Provider Business Practice Location Address City Name:
SLC
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-955-0690
Provider Business Practice Location Address Fax Number:
801-955-2540
Provider Enumeration Date:
11/17/2006