Provider First Line Business Practice Location Address:
36 S STATE ST
Provider Second Line Business Practice Location Address:
MEDICAL GROUP - FINANCE DEPARTMENT
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:
84111-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-442-2997
Provider Business Practice Location Address Fax Number:
801-442-2867
Provider Enumeration Date:
06/11/2006