Provider First Line Business Practice Location Address:
8142 S STATE ST
Provider Second Line Business Practice Location Address:
ATE 103
Provider Business Practice Location Address City Name:
MIDVALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84047-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-708-9226
Provider Business Practice Location Address Fax Number:
877-822-8366
Provider Enumeration Date:
06/24/2011