Provider First Line Business Practice Location Address:
2280 W ALEXANDER ST
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:
84119-2051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-266-3999
Provider Business Practice Location Address Fax Number:
801-685-2264
Provider Enumeration Date:
09/07/2006