Provider First Line Business Practice Location Address:
530 E 500 S
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:
84102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-747-8000
Provider Business Practice Location Address Fax Number:
801-747-8001
Provider Enumeration Date:
04/04/2008