Provider First Line Business Practice Location Address:
166 E 5900 S
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:
84107-7257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-266-1412
Provider Business Practice Location Address Fax Number:
801-288-2269
Provider Enumeration Date:
07/31/2006