Provider First Line Business Practice Location Address:
295 S CHIPETA WAY
Provider Second Line Business Practice Location Address:
UNIVERSITY OF UTAH DEPARTMENT OF PEDIATRICS
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:
84108-1287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-585-6943
Provider Business Practice Location Address Fax Number:
801-581-3899
Provider Enumeration Date:
07/12/2005