Provider First Line Business Practice Location Address:
3745 WEST 4700 SOUTH
Provider Second Line Business Practice Location Address:
FAMILY PRACTICE
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-840-2100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2010