Provider First Line Business Practice Location Address:
5005 S 900 E
Provider Second Line Business Practice Location Address:
SUITE 100
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:
84117-5788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-598-8228
Provider Business Practice Location Address Fax Number:
801-262-7567
Provider Enumeration Date:
08/19/2013