Provider First Line Business Practice Location Address:
100 N MARIO CAPPECHI DR
Provider Second Line Business Practice Location Address:
PRIMARY CHILDRENS MEDICAL CENTER DEPT OF PATHOLOGY
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:
84113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-662-2164
Provider Business Practice Location Address Fax Number:
801-662-2165
Provider Enumeration Date:
06/24/2008