Provider First Line Business Practice Location Address:
3540 S MAIN ST
Provider Second Line Business Practice Location Address:
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:
84115-4435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-281-8688
Provider Business Practice Location Address Fax Number:
801-281-4159
Provider Enumeration Date:
02/07/2007