Provider First Line Business Practice Location Address:
50 NORTH MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
DIVISION OF GENERAL PEDIATRICS
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:
84312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-1017
Provider Business Practice Location Address Fax Number:
801-581-3899
Provider Enumeration Date:
09/27/2005