Provider First Line Business Practice Location Address:
100 N MEDICAL DR
Provider Second Line Business Practice Location Address:
PRIMARY CHILDREN'S MEDICAL CENTER
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:
84113-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-849-8276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2007