Provider First Line Business Practice Location Address:
3802 S 700 E
Provider Second Line Business Practice Location Address:
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:
84106-1182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-264-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2026