Provider First Line Business Practice Location Address:
1200 E 3900 S
Provider Second Line Business Practice Location Address:
NMOB 3300
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:
84124-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-268-7931
Provider Business Practice Location Address Fax Number:
801-270-3318
Provider Enumeration Date:
07/10/2006