Provider First Line Business Practice Location Address:
420 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
#312 - MONARCH DENTAL ADMINISTRATION OFFICE
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:
84111-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-220-0940
Provider Business Practice Location Address Fax Number:
801-220-0139
Provider Enumeration Date:
01/29/2006