Provider First Line Business Practice Location Address:
DIVISION OF GERIATRICS SCHOOL OF MEDICINE
Provider Second Line Business Practice Location Address:
30 N 1900 E, ROOM AB193
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:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-587-9103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2011