Provider First Line Business Practice Location Address:
140 W 2100 S
Provider Second Line Business Practice Location Address:
SUITE 244
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:
84115-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-231-8387
Provider Business Practice Location Address Fax Number:
801-660-2474
Provider Enumeration Date:
01/11/2012