Provider First Line Business Practice Location Address:
65 N MEDICAL DR
Provider Second Line Business Practice Location Address:
SURGERY DEPARTMENT
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:
84132-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-3195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007