Provider First Line Business Practice Location Address:
175 N MEDICAL DR E
Provider Second Line Business Practice Location Address:
UNIVERSITY OF UTAH HOSPITAL, DEPT. OF NEUROLOGY
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:
801-585-6387
Provider Business Practice Location Address Fax Number:
801-581-4192
Provider Enumeration Date:
03/30/2017