Provider First Line Business Practice Location Address:
3808 S WEST TEMPLE
Provider Second Line Business Practice Location Address:
SUTIE 150
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:
84115-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-265-8000
Provider Business Practice Location Address Fax Number:
801-265-8004
Provider Enumeration Date:
10/18/2006