Provider First Line Business Practice Location Address:
2880 W 4700 S
Provider Second Line Business Practice Location Address:
SUITE B
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:
84118-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-982-1404
Provider Business Practice Location Address Fax Number:
801-982-1365
Provider Enumeration Date:
06/14/2010