Provider First Line Business Practice Location Address:
1160 EAST 3900 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 5000
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:
84124-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-262-8486
Provider Business Practice Location Address Fax Number:
801-284-8699
Provider Enumeration Date:
08/19/2005