Provider First Line Business Practice Location Address:
5471 EAST 2300 NORTH
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-745-3200
Provider Business Practice Location Address Fax Number:
801-745-6115
Provider Enumeration Date:
01/15/2026