Provider First Line Business Practice Location Address:
1939 EAST 5600 SOUTH
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:
84121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-272-2424
Provider Business Practice Location Address Fax Number:
801-272-3826
Provider Enumeration Date:
02/26/2007