Provider First Line Business Practice Location Address:
HEALTH SCIENCES CENTER 30 NO 1900 E STE 2B200
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-7647
Provider Business Practice Location Address Fax Number:
801-581-8955
Provider Enumeration Date:
05/06/2009