Provider First Line Business Practice Location Address:
5333 S ADAMS AVE PKWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
WASHINGTON TERRACE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-479-6200
Provider Business Practice Location Address Fax Number:
801-479-1698
Provider Enumeration Date:
05/07/2007