Provider First Line Business Practice Location Address:
2100 S STATE STREET
Provider Second Line Business Practice Location Address:
S2-300
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:
84114-4575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-468-4707
Provider Business Practice Location Address Fax Number:
385-468-4740
Provider Enumeration Date:
10/21/2015