Provider First Line Business Practice Location Address:
7434 S. STATE STREET
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:
84047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-566-4423
Provider Business Practice Location Address Fax Number:
801-566-4779
Provider Enumeration Date:
10/07/2009