Provider First Line Business Practice Location Address:
1C412 UNIVERSITY MEDICAL CTR
Provider Second Line Business Practice Location Address:
20 NORTH 1900 EAST
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:
84132-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2011