Provider First Line Business Practice Location Address:
911 E 200 S
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:
84102-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-0272
Provider Business Practice Location Address Fax Number:
801-581-3744
Provider Enumeration Date:
03/17/2008