Provider First Line Business Practice Location Address:
1405 WEST 2200 SOUTH
Provider Second Line Business Practice Location Address:
STE 200
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:
84119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-973-0900
Provider Business Practice Location Address Fax Number:
801-973-9571
Provider Enumeration Date:
06/25/2006