Provider First Line Business Practice Location Address:
1537 S MAIN ST
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:
84115-5315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-386-9732
Provider Business Practice Location Address Fax Number:
801-906-8642
Provider Enumeration Date:
03/04/2008