Provider First Line Business Practice Location Address:
555 FOOTHILL DR
Provider Second Line Business Practice Location Address:
MADSEN HEALTH CENTER, INTERNAL MEDICINE
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:
84112-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-9280
Provider Business Practice Location Address Fax Number:
801-581-8937
Provider Enumeration Date:
10/31/2005