Provider First Line Business Practice Location Address:
500 FOOTHILL BLVD
Provider Second Line Business Practice Location Address:
MAIL CODE 112
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:
84148-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-582-1565
Provider Business Practice Location Address Fax Number:
801-584-2587
Provider Enumeration Date:
08/19/2006