Provider First Line Business Practice Location Address:
6910 S HIGHLAND DR STE 4
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:
84121-3087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-231-6820
Provider Business Practice Location Address Fax Number:
801-880-3634
Provider Enumeration Date:
08/24/2005