Provider First Line Business Practice Location Address:
SCHOOL OF MEDICINE 30 N 1900 E
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-290-4003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2023