Provider First Line Business Practice Location Address:
100 NORTH MARIO CAPECCHI DRIVE
Provider Second Line Business Practice Location Address:
INPATIENT THERAPY PRIMARY CHILDREN'S HOSPITAL
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:
84113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-821-6613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2014