Provider First Line Business Practice Location Address:
30 N 1900 E
Provider Second Line Business Practice Location Address:
DIV. PHYSICAL MEDICINE AND REHABILITATION
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:
84132-2115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-386-2519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2011