Provider First Line Business Practice Location Address:
15 MEDICAL DR
Provider Second Line Business Practice Location Address:
EMMA ECCLES JONES MEDICAL SCI, RM 2100
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:
801-581-2507
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2008