Provider First Line Business Practice Location Address:
590 FOOTHILL DRIVE
Provider Second Line Business Practice Location Address:
DENTAL SERVICES
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:
84113-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-569-0011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2014