Provider First Line Business Practice Location Address:
INTERNAL MEDICINE 4B120
Provider Second Line Business Practice Location Address:
50 NORTH MEDICAL DRIVE
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-2547
Provider Business Practice Location Address Fax Number:
801-581-5790
Provider Enumeration Date:
04/29/2010