Provider First Line Business Practice Location Address:
60 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
EAGLE GATE PLAZA, 3RD FLOOR
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:
84111-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-578-5882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006