Provider First Line Business Practice Location Address:
244 W 4860 S
Provider Second Line Business Practice Location Address:
ATTN: JOSEPH URBAN, MD
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:
84107-7986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-252-0057
Provider Business Practice Location Address Fax Number:
435-252-0057
Provider Enumeration Date:
06/21/2006