Provider First Line Business Practice Location Address:
1970 S 200 E
Provider Second Line Business Practice Location Address:
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:
84115-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-486-2348
Provider Business Practice Location Address Fax Number:
801-466-8961
Provider Enumeration Date:
07/30/2006