Provider First Line Business Practice Location Address:
2131 E 2100 S
Provider Second Line Business Practice Location Address:
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:
84109-1128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-474-0355
Provider Business Practice Location Address Fax Number:
801-485-8007
Provider Enumeration Date:
09/15/2006