Provider First Line Business Practice Location Address:
1260 VINE ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84121-1700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-281-3221
Provider Business Practice Location Address Fax Number:
801-281-3217
Provider Enumeration Date:
01/09/2007