Provider First Line Business Practice Location Address:
3738 S 900 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:
84106-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-313-1955
Provider Business Practice Location Address Fax Number:
801-313-1965
Provider Enumeration Date:
10/18/2005