Provider First Line Business Practice Location Address:
1000 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 105
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:
84101-3175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-408-1400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2007