Provider First Line Business Practice Location Address:
1515 W PARLIAMENT AVE
Provider Second Line Business Practice Location Address:
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:
84123-1278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-272-9980
Provider Business Practice Location Address Fax Number:
801-272-9976
Provider Enumeration Date:
08/11/2015