Provider First Line Business Practice Location Address:
50 E SOUTH TEMPLE STE 145
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:
84111-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-236-8879
Provider Business Practice Location Address Fax Number:
866-655-3572
Provider Enumeration Date:
03/08/2010