Provider First Line Business Practice Location Address:
5121 S. COTTONWOOD STREET
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:
84157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-269-2500
Provider Business Practice Location Address Fax Number:
801-269-2690
Provider Enumeration Date:
07/07/2006