Provider First Line Business Practice Location Address:
2120 S 900 E
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:
84106-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-972-5270
Provider Business Practice Location Address Fax Number:
801-606-7346
Provider Enumeration Date:
03/17/2006