Provider First Line Business Practice Location Address:
359 - 8TH AVENUE
Provider Second Line Business Practice Location Address:
ASC
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:
84103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-408-3200
Provider Business Practice Location Address Fax Number:
801-733-5618
Provider Enumeration Date:
08/31/2006