Provider First Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS VA SALT LAKE CITY HCS
Provider Second Line Business Practice Location Address:
500 FOOTHILL DR (00A)
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:
84148-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-584-5656
Provider Business Practice Location Address Fax Number:
801-584-1289
Provider Enumeration Date:
08/05/2006