Provider First Line Business Practice Location Address:
7138 S 2000 E
Provider Second Line Business Practice Location Address:
#106
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:
84121-3757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-942-1800
Provider Business Practice Location Address Fax Number:
801-944-1865
Provider Enumeration Date:
11/18/2005