Provider First Line Business Practice Location Address:
10 S 2000 E
Provider Second Line Business Practice Location Address:
ROOM 448
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:
84112-5880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-587-9636
Provider Business Practice Location Address Fax Number:
801-587-9838
Provider Enumeration Date:
08/30/2008