Provider First Line Business Practice Location Address:
50 NORTH MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-339-9489
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007