Provider First Line Business Practice Location Address:
2040 E MURRAY HOLLADAY RD
Provider Second Line Business Practice Location Address:
STE 209
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:
84117-5142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-273-0306
Provider Business Practice Location Address Fax Number:
801-237-0317
Provider Enumeration Date:
06/15/2006