Provider First Line Business Practice Location Address:
44 N MEDIAL DRIVE
Provider Second Line Business Practice Location Address:
UTAH DEPARTMENT OF HEALTH
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:
84114-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-584-8246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006