Provider First Line Business Practice Location Address:
1130 W CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH SALT LAKE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84054-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-936-4000
Provider Business Practice Location Address Fax Number:
801-936-8975
Provider Enumeration Date:
02/19/2008