Provider First Line Business Practice Location Address:
1950 CIRCLE OF HOPE
Provider Second Line Business Practice Location Address:
CLINIC 1A
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:
84112-5550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-0100
Provider Business Practice Location Address Fax Number:
801-585-7902
Provider Enumeration Date:
05/23/2006