Provider First Line Business Practice Location Address:
2010 S 1000 E
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:
84105-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-583-0900
Provider Business Practice Location Address Fax Number:
801-582-7823
Provider Enumeration Date:
06/21/2012