Provider First Line Business Practice Location Address:
50 NORTH MEDICAL DRIVE 3C120
Provider Second Line Business Practice Location Address:
OTOLARYNGOLOGY ADMINISTRATION OFFICE
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:
84132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-7514
Provider Business Practice Location Address Fax Number:
801-585-5744
Provider Enumeration Date:
07/17/2015