Provider First Line Business Practice Location Address:
699 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
STE 120
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:
84102-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-419-0401
Provider Business Practice Location Address Fax Number:
801-350-9582
Provider Enumeration Date:
05/21/2007