Provider First Line Business Practice Location Address:
203 E BROWNING AVE
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:
84115-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-301-8164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2026