Provider First Line Business Practice Location Address:
2001 S STATE ST
Provider Second Line Business Practice Location Address:
S1500
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:
84190-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-468-2473
Provider Business Practice Location Address Fax Number:
801-468-2838
Provider Enumeration Date:
07/07/2005