Provider First Line Business Practice Location Address:
2188 SOUTH HIGHLAND DRIVE
Provider Second Line Business Practice Location Address:
207 EASTSIDE NATIONAL HEALTH CLINIC
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-474-3684
Provider Business Practice Location Address Fax Number:
801-474-3604
Provider Enumeration Date:
11/13/2006