Provider First Line Business Practice Location Address:
1240 E STRINGHAM AVE RM 2
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:
84106-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-214-1115
Provider Business Practice Location Address Fax Number:
801-340-2115
Provider Enumeration Date:
05/20/2026