Provider First Line Business Practice Location Address: 
3601 S 2700 W
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WEST VALLEY
    Provider Business Practice Location Address State Name: 
UT
    Provider Business Practice Location Address Postal Code: 
84119-3746
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
801-785-8000
    Provider Business Practice Location Address Fax Number: 
801-785-4030
    Provider Enumeration Date: 
10/20/2023