Provider First Line Business Practice Location Address:
1050 E SOUTH TEMPLE
Provider Second Line Business Practice Location Address:
SLRMC
Provider Business Practice Location Address City Name:
SLC
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-953-1184
Provider Business Practice Location Address Fax Number:
801-953-1194
Provider Enumeration Date:
01/30/2007