Provider First Line Business Practice Location Address:
195 WEST 7200 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDVALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84047-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-578-8500
Provider Business Practice Location Address Fax Number:
801-578-8470
Provider Enumeration Date:
01/30/2006