Provider First Line Business Practice Location Address:
8TH AVE C STREET
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:
84143-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-634-4135
Provider Business Practice Location Address Fax Number:
801-408-4710
Provider Enumeration Date:
04/26/2018