Provider First Line Business Practice Location Address:
139 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
SUITE 500
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:
84111-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-746-5693
Provider Business Practice Location Address Fax Number:
801-746-3042
Provider Enumeration Date:
07/22/2011