Provider First Line Business Practice Location Address:
2040 E. MURRAY HOLLADAY RD
Provider Second Line Business Practice Location Address:
SUITE 222
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:
84117-5185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-278-0499
Provider Business Practice Location Address Fax Number:
801-278-0489
Provider Enumeration Date:
04/05/2006