Provider First Line Business Practice Location Address:
1955 S 1300 E STE 3
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:
84105-3683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-487-5807
Provider Business Practice Location Address Fax Number:
801-487-3438
Provider Enumeration Date:
10/06/2006