Provider First Line Business Practice Location Address:
3540 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:
84115-4435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-917-9000
Provider Business Practice Location Address Fax Number:
801-383-9992
Provider Enumeration Date:
07/25/2013