Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH DEPARTMENT OF
Provider Second Line Business Practice Location Address:
30 N 1900 E ROOM 3C 444
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:
84132-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-205-4132
Provider Business Practice Location Address Fax Number:
503-494-7635
Provider Enumeration Date:
06/30/2006