Provider First Line Business Practice Location Address:
1200 E 3300 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:
84106-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-256-6675
Provider Business Practice Location Address Fax Number:
801-990-0503
Provider Enumeration Date:
02/15/2011