Provider First Line Business Practice Location Address:
2480 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
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:
84115-3058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-428-1060
Provider Business Practice Location Address Fax Number:
801-855-5908
Provider Enumeration Date:
08/27/2008