Provider First Line Business Practice Location Address:
26 SOUTH 2000 EAST
Provider Second Line Business Practice Location Address:
SUITE 5900 UNIVERSITY UTAH HOSPITAL
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:
84112-5750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-213-2731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2009