Provider First Line Business Practice Location Address:
150 S 600 E
Provider Second Line Business Practice Location Address:
4C
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:
84102-1999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-364-2779
Provider Business Practice Location Address Fax Number:
801-582-9360
Provider Enumeration Date:
07/21/2010