Provider First Line Business Practice Location Address:
85 N MEDICAL DR # 2122
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:
84112-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-2589
Provider Business Practice Location Address Fax Number:
801-587-5757
Provider Enumeration Date:
04/01/2025