Provider First Line Business Practice Location Address:
500 FOOTHILL BLVD # 111G
Provider Second Line Business Practice Location Address:
VA SLC HEALTH CARE SYSTEM
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:
84148-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-584-1236
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2006