Provider First Line Business Practice Location Address:
1638 S 9TH E
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:
84105-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-484-8742
Provider Business Practice Location Address Fax Number:
801-463-1153
Provider Enumeration Date:
09/13/2009