Provider First Line Business Practice Location Address:
2870 E 3300 S STE 5
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:
84109-2847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-485-0760
Provider Business Practice Location Address Fax Number:
801-485-0963
Provider Enumeration Date:
10/25/2006