Provider First Line Business Practice Location Address:
2420 S 1300 E
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:
84106-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
188-833-2020
Provider Business Practice Location Address Fax Number:
801-274-1543
Provider Enumeration Date:
09/15/2006