Provider First Line Business Practice Location Address:
2180 E FORT UNION BLVD.
Provider Second Line Business Practice Location Address:
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:
84121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-944-4141
Provider Business Practice Location Address Fax Number:
801-944-6377
Provider Enumeration Date:
05/18/2009