Provider First Line Business Practice Location Address:
1220 E 3900 S STE 2C
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:
84124-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-263-2482
Provider Business Practice Location Address Fax Number:
801-263-2424
Provider Enumeration Date:
07/08/2006