Provider First Line Business Practice Location Address:
GEORGE E WAHLEN DEPT OF VETERANS AFFAIRS MEDICAL CTR
Provider Second Line Business Practice Location Address:
500 FOOTHILL DRIVE, DENTAL SERVICE (160)
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:
801-584-1206
Provider Business Practice Location Address Fax Number:
801-584-1251
Provider Enumeration Date:
08/14/2006