Provider First Line Business Practice Location Address:
1040 N 2200 W STE 200
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:
84116-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-331-6353
Provider Business Practice Location Address Fax Number:
801-595-4440
Provider Enumeration Date:
12/12/2006