Provider First Line Business Practice Location Address: 
1100 W 2700 N
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PLEASANT VIEW
    Provider Business Practice Location Address State Name: 
UT
    Provider Business Practice Location Address Postal Code: 
84404-4791
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
801-475-3600
    Provider Business Practice Location Address Fax Number: 
801-475-3601
    Provider Enumeration Date: 
01/22/2007