Provider First Line Business Practice Location Address:
SALT LAKE CLINIC - FAMILY DENTAL PLAN
Provider Second Line Business Practice Location Address:
3195 SOUTH MAIN STREET, SUITE 200
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:
84114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-468-0342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006