Provider First Line Business Practice Location Address:
391 CHIPETA WAY STE C
Provider Second Line Business Practice Location Address:
C/O ROCKY MTN CENTER FOR OCC & ENV HEALTH
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:
84108-1294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-3841
Provider Business Practice Location Address Fax Number:
801-585-3759
Provider Enumeration Date:
01/22/2008