Provider First Line Business Practice Location Address:
2040 E 4800 S
Provider Second Line Business Practice Location Address:
SUITE 208
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:
84117-5185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-278-7100
Provider Business Practice Location Address Fax Number:
801-278-1697
Provider Enumeration Date:
05/24/2006