Provider First Line Business Practice Location Address:
100 N MEDICAL DR
Provider Second Line Business Practice Location Address:
PRIMARY CHILDREN'S MEDICAL CENTER PEDIATRIC CARDIOLOGY
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:
84113-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-662-5400
Provider Business Practice Location Address Fax Number:
801-662-5404
Provider Enumeration Date:
05/22/2008