Provider First Line Business Practice Location Address:
1414 E 4500 S
Provider Second Line Business Practice Location Address:
SUITE 4
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:
84117-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-272-8957
Provider Business Practice Location Address Fax Number:
801-272-3724
Provider Enumeration Date:
02/22/2006